Left Renal Vein to Inferior Vena Cava Pressure Relationship in Humans

Beinart, Clifford; Sniderman, Kenneth W.; Tamura, Shozo; Vaughan, E. Darracott; Sos, Thomas A.

doi:10.1016/s0022-5347(17)54230-5

Cited by 100 publications

(46 citation statements)

References 10 publications

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“…[48][49][50] It varies from microhematuria to macrohematuria, occasionally with resultant anemia that requires blood transfusions. 3,[50][51][52][53][54][55] Cystoscopy may identify a left ureteral origin. 22,24,50,56,57 In a study by Shin et al, 30 the causes of isolated hematuria could not be identified by routine methods in 69% of pediatric cases.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

443

586

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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Section: Clinical Featuresmentioning

confidence: 99%

“…On the basis of these data, LRV hypertension occurs when the gradient is 3.0 mm Hg. 53,54 Normal left gonadal vein diameter approximates 3 mm. 37,58,93 Ovarian veins (left more commonly than right) can show reflux in healthy asymptomatic parous women.…”

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

443

586

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“…However, diagnostic and therapeutic criteria have not been adequately established and the natural history of NCS is not well understood. In the past, the demonstration of the increased gradient between the LRV and inferior vena cava (normal, <1 mmHg) on renal venography was widely used for diagnosis of NCS [4]. More recently, renal Doppler US has become the most useful initial non-invasive diagnostic method by showing the peak blood flow velocity of LRV [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

The utility of bioimpedance analysis for monitoring the children with nutcracker syndrome

Yavuz

Kıyak

et al. 2015

Eur J Pediatr

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“…A valid criterion to diagnose NCS is the elevated gradient (Ͼ3 mm Hg) between the LRV and IVC. 4 The aim of various surgical approaches is to relieve LRV hypertension and increase renal venous outflow.…”

Section: Discussionmentioning

confidence: 99%

Left renocaval venous bypass with autologous great saphenous vein for nutcracker syndrome

Liu

Sun

Xing

2012

Journal of Vascular Surgery

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Nutcracker syndrome results from left renal vein compression by the abdominal aorta and the superior mesenteric artery. The consecutively increased renal venous pressure results in hematuria, proteinuria, flank pain, left-sided varicocele, pelvic congestion, and others. We report a 25-year-old man with nutcracker syndrome who underwent successful left renocaval venous bypass with autologous great saphenous vein. The patient's condition clearly improved, with no clinical relapse after treatment. Ultrasound imaging showed patency of the venous bypass and decreased venous hypertension. This technique is a feasible choice for surgical treatment of nutcracker syndrome, with a low incidence of complications and satisfactory results.

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Left Renal Vein to Inferior Vena Cava Pressure Relationship in Humans

Cited by 100 publications

References 10 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

The utility of bioimpedance analysis for monitoring the children with nutcracker syndrome

Left renocaval venous bypass with autologous great saphenous vein for nutcracker syndrome

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