Surgical Treatment of a Patient With Nutcracker Syndrome via Transposition of the Left Renal Vein

Borislav Denchev; Elena Domuschieva; Galin Jelev; Valentin Govedarski; Todor Zahariev

doi:10.1016/j.ejvssr.2018.09.003

Surgical Treatment of a Patient With Nutcracker Syndrome via Transposition of the Left Renal Vein

EJVES Short Rep. 2018 Oct 29:41:10-12. doi: 10.1016/j.ejvssr.2018.09.003. eCollection 2018.

Authors

Borislav Denchev¹, Elena Domuschieva¹, Galin Jelev¹, Valentin Govedarski², Todor Zahariev²

Affiliations

¹ Virgin Mary University Hospital, Clinic of Vascular Surgery, Bourgas, Bulgaria.
² Saint Ekaterina University Hospital, Clinic of Vascular Surgery, Sofia, Bulgaria.

Abstract

Introduction: Nutcracker syndrome (NCS) is caused by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA) where it passes in the fork formed at the bifurcation of these arteries. NCS leads to LRV hypertension, resulting in left flank and abdominal pain, with or without haematuria and pelvic ureteral varices.

Report: The patient was a young female with diagnostic criteria of NCS, with severe clinical manifestations. The patient underwent transposition of the LRV approximately 3.0 cm below the original anatomic site and was anastomosed to the inferior vena cava (IVC) outside the meso-aortic compression zone.

Conclusion: Although NCS is not as common as other clinical scenarios, it may be encountered by physicians in a variety of disciplines, and can cause substantial morbidity and mortality rates. This report addresses the surgical approach used in a particular case, as well as the possible complications and outcomes if not treated in due time.

Keywords: Flank pain; Haematuria; Nutcracker syndrome; Renal vein.

Publication types

Case Reports