Nutcracker Syndrome Secondary to Bariatric Surgery

Fernández-Pacheco, Borja Camacho; Fernández, Eudaldo López-Tomassetti; Hernández, Juan Ramón Hernández

doi:10.1007/s11695-017-2893-1

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Combined (anterior and posterior) NCS has also been reported, resulting from a circumaortic or duplicated LRV with both components stenosed by extrinsic compression (8). Still rarer etiologies of LRV compression include compression by adjacent lymphadenopathy or malignancy (9), severe lordosis (10), pregnancy (11), intestinal malrotation (12), and rapid weight loss (13).…”

Section: Etiologymentioning

confidence: 99%

Nutcracker syndrome: diagnosis and therapy

Kolber¹,

Cui²,

Chen³

et al. 2021

Cardiovasc Diagn Ther

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Nutcracker syndrome (NCS) is an extrinsic compression of the left renal vein (LRV) by the superior mesenteric artery (SMA) anteriorly and aorta posteriorly resulting in renal vascular congestion manifesting as hematuria, proteinuria, orthostatic hypotension, pain, or even renal dysfunction. Longstanding venous compression can encourage collateral drainage pathways through gonadal and pelvic veins, which may explain reported symptom and syndrome overlap with pelvic congestion syndrome. Diagnosis can be challenging and variable, frequently involving a combination of ultrasound Doppler, cross-sectional, and invasive imaging. Often, intravascular pressure measurements are required to prove a renocaval pressure gradient to aid in a definitive diagnosis. Conservative management is appropriate, especially in children, who tend to outgrow the disorder. In the interim, medical management with angiotensin converting enzyme inhibitors (ACEIs) is a useful therapy to manage orthostatic hypotension in the pediatric population.In adults, invasive therapies are more frequently pursued. These are aimed at relieving the extrinsic compression on the LRV. The standard of care is renal vein transposition, with renal autotransplantation reserved for recalcitrant cases. Endovascular stenting is a less invasive option. Laparoscopic placement of an exovascular stent is a newer therapy intended to minimize trauma to the LRV. In this review, we will discuss the clinical manifestations, diagnostic criterion, imaging features, and conservative and surgical therapies for this condition.

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Section: Etiologymentioning

confidence: 99%

Nutcracker syndrome: diagnosis and therapy

Kolber¹,

Cui²,

Chen³

et al. 2021

Cardiovasc Diagn Ther

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“…3 Even rarer etiologies of LRV compression include severe lordosis intestinal malrotation and fast weight loss. [8][9][10] Figure 1 (A-D): Normal variants in the aortomesenteric angle (red circle).…”

Section: Introductionmentioning

confidence: 99%

Nutcracker syndrome: a review

Ramos-Peralta,

Lacayo-Valenzuela,

Sierra-Juárez

et al. 2023

Int J Res Med Sci

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Left renal vein (LRV) entrapment is an anatomic condition characterized by extrinsic compression of the renal vein and consequent impaired inferior vena cava (IVC) outflow. Nutcracker syndrome (NCS) can be caused by compression of the LRV between the aorta and the superior mesenteric artery or by compression of LRV between vertebral bodies and the aorta. The most common presentations in NS include pelvic or left flank pain, hematuria, gonadal varices, thus the hallmark manifestations of NCS may be related to renal venous congestion and increased pressure within the venous structures. Computed tomography, magnetic resonance imaging and doppler ultrasonography are reasonable imaging studies in patients with suspected NCS, but invasive evaluation with catheter venography and pressure measurement is often required to the definitive diagnosis. For now, it is not possible to standardize a treatment modality, although the trend towards endovascular management is clear; therapeutic strategies with open surgery should not be lost for those cases that correspond to this.

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Analysis on the Principles of Primary Liver Cancer Prescriptions Based on Association Rules and Entropy Clustering of Complex Systems

乔¹

2021

TCM

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Nutcracker Syndrome Secondary to Bariatric Surgery

Cited by 3 publications

References 9 publications

Nutcracker syndrome: diagnosis and therapy

Nutcracker syndrome: diagnosis and therapy

Nutcracker syndrome: a review

Analysis on the Principles of Primary Liver Cancer Prescriptions Based on Association Rules and Entropy Clustering of Complex Systems

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