The nutcracker syndrome: Its role in the pelvic venous disorders

Scultetus, Anke; Villavicencio, J. Leonel; Gillespie, David L.

doi:10.1067/mva.2001.118802

Cited by 203 publications

(162 citation statements)

References 36 publications

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“…Because the left gonadal vein drains into the LRV, males may experience left testicular pain and females may experience symptoms similar to pelvic congestion, such as pelvic pain dysmenorrhoea, dysuria and dyspareunia. It can lead to varcicocele formation in males, and vulvar and pelvic varices in females [25]. Varicose veins of the lower extremities can also develop as a result of increased pelvic pressure.…”

Section: Managementmentioning

confidence: 99%

Venous compression syndromes: clinical features, imaging findings and management

Butros¹,

Liu²,

Oliveira³

et al. 2013

BJR

134

206

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Extrinsic venous compression is caused by compression of the veins in tight anatomic spaces by adjacent structures, and is seen in a number of locations. Venous compression syndromes, including Paget-Schroetter syndrome, Nutcracker syndrome, May-Thurner syndrome and popliteal venous compression will be discussed. These syndromes are usually seen in young, otherwise healthy individuals, and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, CT, or MR conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method.

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Section: Managementmentioning

confidence: 99%

Venous compression syndromes: clinical features, imaging findings and management

Butros¹,

Liu²,

Oliveira³

et al. 2013

BJR

134

206

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“…The pain is exacerbated by sitting, standing, walking, or riding in a vehicle that shakes. 36,58,59 Left flank pain can also be due to left ureteral colic, from the passing of blood clots down the left ureter.…”

Section: Clinical Featuresmentioning

confidence: 99%

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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“…43,44 Systemic manifestations including headache, abdominal pain, fainting, and tachycardia mimicking clinical symptoms of an orthostatic disturbance have also been reported in adolescents. 45 …”

Section: Clinical Presentationmentioning

confidence: 99%

“…Gonadocaval bypass using an H-graft fashioned out of either saphenous vein or Dacron prosthetic grafts has been successfully performed. 44 Left vein transposition through transperitoneal exposure involves division of the left renal vein at its junction with the inferior vena cava. A large series from the Mayo Clinic demonstrated the procedure's safety and efficacy for resolution of severe flank pain and hematuria.…”

Section: Treatmentmentioning

confidence: 99%

Nonatherosclerotic Obstructive Vascular Diseases of the Mesenteric and Renal Arteries

Escárcega

Mathur

Franco

et al. 2014

Clinical Cardiology

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Nonatherosclerotic vascular diseases of the mesenteric and renal arteries are considered to occur less frequently than those caused by occlusive atherosclerotic disease. However, when present, they pose a significant diagnostic and therapeutic challenge. Such disorders include fibromuscular dysplasia, median arcuate ligament syndrome, the renal nutcracker syndrome, and some forms of acute and chronic mesenteric ischemia (embolic and thrombotic). This is a heterogeneous group of disorders with substantial differences in the pathogenesis and diagnostic approaches to these diseases. We provide an overview of the pathogenesis, clinical presentation, diagnosis, and current management of fibromuscular dysplasia, median arcuate ligament syndrome, and the renal nutcracker syndrome.

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The nutcracker syndrome: Its role in the pelvic venous disorders

Cited by 203 publications

References 36 publications

Venous compression syndromes: clinical features, imaging findings and management

Venous compression syndromes: clinical features, imaging findings and management

Nutcracker Phenomenon and Nutcracker Syndrome

Nonatherosclerotic Obstructive Vascular Diseases of the Mesenteric and Renal Arteries

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