Transposition of the Left Renal Vein in Nutcracker Syndrome

Kim, J.Y.; Joh, Jin Hyun; Choi, Hyunsook; Do, Yongtae; Shin, Sumin; Kim, D.I.

doi:10.1016/j.ejvs.2005.08.012

Cited by 35 publications

(16 citation statements)

References 10 publications

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“…47 For patients younger than 18 years, the best option is a conservative approach with observation for at least 2 years because as many as 75% of patients will have complete resolution of hematuria. 34,[110][111][112] Angiotensin inhibitors may be helpful in improving orthostatic proteinuria in patients with NCS. 41,42,45 The correlation between imaging evidence of LRV compression and clinical symptoms remains challenging, and therefore interventions should be considered only when symptoms are severe or persistent, including severe unrelenting pain, severe hematuria, renal insufficiency, and failure to respond to conservative treatment after 24 months.…”

Section: Treatmentmentioning

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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Section: Treatmentmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

443

586

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“…6,7 The originality of our technique was that we performed both these steps at one time. A large dissection of the LRV trunk and sectioning the LRV trunk collaterally were necessary to perform the transposition without tension on the sutures.…”

Section: Discussionmentioning

confidence: 99%

Associated Da Vinci and Magellan Robotic Systems for Successful Treatment of Nutcracker Syndrome

Thaveau

Nicolini²,

Lucereau³

et al. 2015

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Here, we report the case of a 26-year-old woman suffering from nutcracker syndrome with concurrent disabling pelvic congestion syndrome. She was given the minimally invasive treatment of left renal vein transposition with the Da Vinci(®) robotic system (Intuitive Surgical, Sunnyvale, CA), followed the next day by a gonadal vein and pelvic varicose embolization using a robotic intraluminal navigation with the Magellan™ robotic system (Hansen Medical, Mountain View, CA). The procedure was uneventful, and the patient had good results at 6 months of follow-up, including a patent left renal vein and complete relief of symptoms.

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“…Several surgical approaches have been previously described, including Gore-Tex graft vein interposition, transposition of the left renal vein [7], nephropexy, stenting, renocaval reimplantation, and renal autotransplantation [8, 9]. However, these surgical approaches are invasive and are not established as the gold standard.…”

Section: Discussionmentioning

confidence: 99%

A Case of the Nutcracker Syndrome Developed after Delivery

Tsumura

Yoshida

Yamamoto

et al. 2014

Case Reports in Urology

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We report a case of nutcracker syndrome that developed after delivery. A 32-year-old woman visited our clinic complaining of gross hematuria 4 months after delivery. Urethrocystoscopic examination failed to show hematuria coming from the ureteral orifice; however, enhanced computed tomography revealed the compression of the left renal vein between the aorta and superior mesenteric artery. Therefore, we diagnosed her with nutcracker syndrome and conservatively observed her. The macrohematuria disappeared by itself after 1 month. This is the first report to describe a case of nutcracker syndrome that developed after delivery.

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Transposition of the Left Renal Vein in Nutcracker Syndrome

Cited by 35 publications

References 10 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Associated Da Vinci and Magellan Robotic Systems for Successful Treatment of Nutcracker Syndrome

A Case of the Nutcracker Syndrome Developed after Delivery

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