A 52yearold woman who had a history of hematuria two years previously was admitted to another hospital for treatment of recurrent hematuria. We present a patient whose complaint of flank pain led to the diagnosis of a renal vein thrombosis. Figure 5 placement of the stent in the left renal vein. Endovascular stenting for treatment of nutcracker syndrome. Results are encouraging at followup periods beyond two. Nutcracker syndrome with pelvic congestion treated by. It was described for the first time in 1996 by nesteet al. Dec 01, 20 read surgical and endovascular interventions for nutcracker syndrome, seminars in vascular surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. If hematuria is not present it is termed nutcracker phenomenon.
Endovascular treatment of posterior nutcracker syndrome. Ruzsa z aimradial 2014 endovascular carotid artery. Ruzsa z aimradial 2014 endovascular carotid artery stenting 1. Jul 24, 2015 nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. A look at ascending aorta repair by endovascular stent grafting. The purpose of this study was to evaluate late results of lrv transposition and identify risk factors affecting outcomes. In cases of nutcracker syndrome, the left renal vein was stenosed between the. Oct 27, 2009 nutcracker syndrome ncs is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery sma. The nutcracker syndrome ncs is a rare cause of haematuria.
We report a case of migration of a laparoscopically. All these procedures were performed by one experienced interventional. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the. The axillary artery, and the brachial artery were used less frequently 4,8,14,28. Results of endovascular treatment for patients with nutcracker. Aug 31, 2017 minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Endovascular interventions have become the treatment of choice for most cases of cbos. Endovascular therapy provides an alternative therapy with satisfactory longterm clinical and imaging results for symptomatic patients with nutcracker syndrome. Flow chart showing how ncs is diagnosed following a pathway from initial. In addition, embolization of the pseudoaneurysm before or after stenting to cover the neck of the pseudoaneurysm may be needed. Endovascular stenting randwick angioplasty sydney nsw. Nutcracker syndrome is an entity resulting from left renal vein compression by.
Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. Five stents were used in four carotid arteries in four consecutive patients with carotid stenosis of at least 70%. Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta, leading to symptoms of hematuria and left flank pain. Nutcracker syndrome and hypertension radiology case. Chen et al have shown, in a longer followup of 61 patients, that endovascular stenting is a primary option for ncs. Followup included a neurological examination, carotid duplex scan, and of. Percutaneous angioplasty and stenting for symptomatic lrv compression and the nutcracker syndrome is an excellent alternative to more invasive approaches. Endovascular stenting for nutcracker syndrome sciencedirect. It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein. Nutcracker syndrome, first reported in 1972, is characterized by hematuria and back pain caused by increased pressure in the lrv as a result of compression between the aorta and the sma. This case illustrates the features of nutcracker syndrome, also known as renal vein entrapment syndrome, and an uncommon cause of secondary hypertension. The small intestines hang like baggy sausages off the branched stems of the superior mesenteric artery sma, and in some individuals, the sma. I reached out on instagram and found many others with this disease.
Similar to stents in the heart to treat a heart attack, stents and balloons are used by endovascular surgeons to treat blocked arteries throughout the body. Looking at it from a transverse plane both sma and aorta. Although nutcracker syndrome ns is rare, patients presenting with symptoms or signs and anatomic compression of the left renal vein lrv can be considered for intervention. We report a rare cause if a 12yearold boy who presented with a history of frequent intermittent episodes of painless constant haematuria.
The nutcracker syndrome ncs is a described as a mesoaortic compression of the left renal vein between the abdominal aorta and the superior mesenteric artery together with hematuria. Endovascular treatment of nutcracker syndrome scielo. From the peripheral vascular surgery society left renal vein transposition for nutcracker syndrome nanette r. Endovascular stent placement for nutcracker phenomenon ios. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or. Pdf endovascular stenting for nutcracker syndrome researchgate. We report a rare cause if a 12yearold boy who presented with a history of frequent intermittent episodes of painless constant. Vascular thoracic outlet syndrome vtos is categorized as disorders of the upper extremity, which are caused by compression of the brachial plexus and subclavian artery or vein by bony, soft tissue or muscular anomalies as they emerge from the thoracic outlet. Endovascular treatment of carotid angioplasty stenting compared with carotid endarterectomy 52 p j m h s vol.
Left renal vein transposition for nutcracker syndrome. After attempted percutaneous endovascular removal of the stent failed the protruding stent in the collateral was removed and the remaining stent was pushed into the lrv trunk via a venotomy. Nutcracker syndrome with pelvic congestion treated by balloon. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. Vascular thoracic outlet syndrome vascular surgery. Lrv transposition is the most commonly described surgical approach successfully utilized to alleviate pelvic congestion symptoms and hematuria. In this case, abdominal computed tomography angiography was helpful in diagnosing the nutcracker syndrome complicated by the renal vein thrombosis. Nutcracker syndrome, endovascular stent, hematuria. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration. Although endovascular stenting is well accepted for iliocaval occlusive disease. After failed conservative approach, she underwent endovascular stenting and. She had surgery, which is left renal vein transposition, where. A 21yearold chinese woman was admitted with a sevenmonth history of unilateral severe hematuria.
Several treatment options have been described to relieve associated symptoms. Pdf nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in. A 30yearold female was diagnosed with nutcracker syndrome for severe left flank pain. It should not be confused with with superior mesenteric artery syndrome aka wilkie syndrome which although also a superior mesenteric artery compression disorder, the sma compresses the. In certain situations, the syndrome can result from a retroaortic or circumaortic left renal vein nutcracker syndrome should not be confused with superior mesenteric artery syndrome wilkie syndrome also a superior mesenteric artery compression disorder, where the sma compresses the third part of the duodenum the two conditions, however, may be associated. Minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Nutcracker syndrome ncs is caused by compression of the left renal vein lrv.
Culotte stenting favored for coronary bifurcation lesions. Considering the process neednt to transplant lrv or to insert entovascular stent, extravascular stenting is a feasible, safe option for the nutcracker syndrome. Extravascular stent management for migration of left renal. Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. However, currently, there are few data about the pure endovascular approach in the posterior nutcracker syndrome related to evolution in the midterm. Nutcracker syndrome ncs is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery sma. Endovascular stenting in the treatment of pelvic vein congestion. Conventional surgery involves procedures that are associated with increased. Methods fifteen selective lcca stenosis patients were treated by the modified no touch technique in the antegrade endovascular. Current management approach for left renal vein entrapment.
Anticoagulation was started and three weeks later, cta showed complete disappearance. Nutcracker syndrome is an entity resulting from left renal vein. She had surgery, which is left renal vein transposition, where her symptoms resolved for about two weeks. Nutcracker syndrome is the term used to describe the patient with clinical symptoms of entrapment of the left renal vein between the aorta and the superior mesenteric artery. While these procedures have largely been abandoned due to attendant. We present a case of a 54yearold female with chronic lower abdominal pain radiating to the left thigh of 4 years in duration.
Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. However, further followup and investigation will be required to determine if the durability of this approach compares favorably to current open options for this rare condition. Posterior nutcracker syndrome with left renal vein. Compression of the left renal vein lrv between the superior mesenteric artery sma and the aorta was. Application of extravascular stenting for nutcracker. Endovascular stenting for nutcracker syndrome kuokang feng, chunyang huang, chenyuan hsiao, tsunghsing lee, tzuting kuo, chunche shih, chiaopo hsu division of cardiovascular surgery, department of surgery, taipei veterans general hospital and national yangming university school of medicine, taipei, taiwan, roc. Surgical and endovascular interventions for nutcracker syndrome. It was described for the first time in 1996 by neste et al.
Renal vein stenting for nutcracker syndrome endovascular today. Placement of left renal venous stent for nutcracker syndrome. Nutcracker syndrome describes an array of incapacitating symptoms caused by lrv. Further studies should report if this approach has adverse effects and if such a. Radcar study radial access for carotid artery stenting. Jul 14, 2017 nutcracker syndrome is one of the many unfortunate consequences of our bipedal lifestyle. Endovascular stenting for nutcracker syndrome kuokang feng, chunyang huang, chenyuan hsiao, tsunghsing lee, tzuting kuo. We finally went to mayo clinic and she was diagnosed there. Nutcracker syndrome servier phlebolymphologyservier. The small intestines hang like baggy sausages off the branched stems of the superior mesenteric artery sma, and in some individuals, the sma compresses the left renal vein against the aorta. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome lu tian1, shanwen chen2, gaoyue zhang3, hongkun zhang1, wei jin1 and ming li1 abstract background. Carotid artery angioplasty with stenting cas is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Jun 22, 2017 renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. Carotid blowout syndrome emergent endovascular management by.
Endovascular angioplasty with stenting cas treatment. Nutcracker syndrome, or mesoaortic compression of the left. Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome. A simplified approach with gonadal vein transposition posted on june 12, 2016 june 12, 2016 by docpark the patient is a young woman in her twenties who developed severe right sided abdominal and back pain about 4 months prior to. She was diagnosed in april 2009 after over a year and a half of trying to figure out what was wrong. We describe our initial clinical experience using the newly available selfexpanding, nitinol, shapememory, alloyrecoverabletechnology smart stent in treating carotid artery occlusive disease.
Postoperative complications included stent migration to the right atrium after a failed attempt at percutaneous endovascular stent removal. Endovascular treatment by stenting was proposed and is not very invasive, but followup is too short to establish the role of this technique in the management of the nutcracker syndrome. She underwent successful extravascular stenting with complete symptom resolution. Endovascular repair of the ascending aorta can be an effective lifesaving therapy in the properly selected patient and may serve as a bridging therapy to open repair in others. Vascular tos usually occurs in young patients and athletes who are involved in repetitive overhead motion, such as swimming or baseball. More recently, endovascular stenting of the left renal vein has been reported. Endovascular stenting has shown promising longterm resolution of symptoms but can be complicated by stent migration or thrombosis. Nutcracker syndrome european journal of vascular and. Open, laparoscopic, and endovascular techniques have been developed to decrease the venous outflow obstruction of the lrv. Though lrv transposition and now lrv stenting are commonly employed methods for treatment of nutcracker syndrome, judicious management of ncs should take into consideration patients age, severity, and chronicity of symptoms along with current lack of data regarding longterm outcomes of stent placement. Nutcracker syndrome ncs describes left renal vein compression. The procedures were performed in the operating room with a portable c arm.
We reported a case of successful endovascular stenting of the left renal vein for nutcracker syndrome. Some people may not have symptoms, while others develop severe and. My daughter has nutcracker syndrome testicular disorders. Renal vein stenting for nutcracker syndrome endovascular. Nutcracker syndrome, caused by compression of the left renal vein lrv between the superior mesenteric artery and the aorta, results in left renal and gonadal venous hypertension. The brachial artery approach offers a better chance of crossing a complex lesion, but is associated with more access site complications. After failed conservative approach, she underwent endovascular stenting and subsequently developed recurrent symptom for stent migration one month postoperatively. Jul 24, 2015 a 30yearold female was diagnosed with nutcracker syndrome for severe left flank pain. This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome ncs who were.
Endovascular treatment of nutcracker syndrome request pdf. Technical success nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Endovascular stenting and angioplasty is a new and evolving minimally invasive method to treat circulatory disorders caused by diseased arteries. It can be easily overlooked, and should be considered in young men or women with symptoms of extended duration. Read surgical and endovascular interventions for nutcracker syndrome, seminars in vascular surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Ultimately it may be associated with substantial morbidity and even lifethreatening events. The no touch technique used in the renal artery was modified for this situation. Renal nutcracker syndrome genetic and rare diseases. Endovascular treatment of nutcracker syndrome sciencedirect. Ricotta ii, md, aand peter gloviczki, md, rochester, minn objective. Varicoceles, in the setting of nutcracker syndrome, may need independent repair.
A randomised comparison of transradial and transfemoral approach for carotid artery stenting. Pdf a minimally invasive alternative for the treatment. Endovascular stent placement for nutcracker phenomenon. The endovascular therapy of the nutcracker syndrome ncs. Management of renal nutcracker syndrome by retroperitoneal. Robotassisted laparoscopic extravascular stent for. A simplified approach with gonadal vein transposition posted on june 12, 2016 june 12, 2016 by docpark the patient is a young woman in her twenties who developed severe right sided abdominal and back pain about 4 months prior to presentation associated with bouts of bloody urine. There are many modalities of treatment of nutcracker syndrome. Nutcracker syndrome complicated by left renal vein thrombosis. Surgical and endovascular interventions for nutcracker. Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures. Safety and efficiency of endovascular treatment of carotid. Nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in males and females alike.
The mainstay of therapy is stent placement covered or uncovered, selfexpanding or balloon expandable. Patients of nutcracker syndrome having the only symptom of significant varicocele are recommended for surgery from our experience. Laparoscopic extravascular stent placement has shown promising results with the potential to avoid these complications. In addition, embolization of the pseudoaneurysm before or after stenting to. Nutcracker syndrome, caused by compression of the left renal vein lrv between the superior mesenteric. Results are encouraging at followup periods beyond 2 years. Adjunctive procedures to optimize venous outflow included great saphenous vein cuff. Nutcracker syndrome is one of the many unfortunate consequences of our bipedal lifestyle. The endovascular treatment of nutcracker syndrome is currently considered by some to be the preferred treatment option in this pathologic process despite its risks. Extravascular stent management for migration of left renal vein. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a bovine aortic arch.
Is a complex of clinical symptoms that results from nutcracker phenomenon ncp ncs can be found any time from childhood to old age, with a relatively high prevalence in young and middleaged adults no difference between the sexes. Endovascular management of nutcracker syndrome after. Background open surgery and the retrograde endovascular approach via the distal left common carotid artery lcca have some limitations in lcca ostial stenosis treatment. Feb 24, 2015 a look at ascending aorta repair by endovascular stent grafting.