In Situ Gonadal Vein Valvulotomy and Side-to-side Gonado-iliac Bypass for the Management of Nutcracker Syndrome in an Adolescent With a Solitary Kidney and Absence of Pelvic Congestion

The nutcracker phenomenon refers to compression of the left renal vein at the origin of the superior mesenteric artery and is often underdiagnosed. This can cause symptoms of pelvic venous congestion with retrograde venous flow and a dilated gonadal vein. Here we describe a case in a 39-year-old female, who following imaging investigations to confirm the diagnosis, underwent transperitoneal laparoscopic ligation of the left gonadal vein. Laparoscopic sterilization was also performed with the aid of the gynecologists. Multiparous women, who are more likely to develop pelvic congestion symptoms, more commonly request sterilization and thus we propose that a dual laparoscopic procedure in these cases could be the treatment of choice.

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The desperate plea of women with the nutcracker syndrome

Phlebologie ◽

10.1055/s-0037-1622296 ◽

2010 ◽

Vol 39 (02) ◽

pp. 104-111

Author(s):

J. L. Villavicencio

Keyword(s):

Renal Vein ◽

Imaging Techniques ◽

Left Renal Vein ◽

Diagnostic Tools ◽

Nutcracker Syndrome ◽

Treatment Techniques ◽

Children And Young Adults ◽

Good Number ◽

Pelvic Congestion

Summary Objective: To increase awareness on the severe impact of the nutcracker syndrome in women with undiagnosed disease. Patients and methods: We reviewed the medical literature and analyzed six representative series with 73 patients with nutcracker syndrome. Women with left flank pain, dyspareunia, dysuria, dysmenorrhea, micro- or macrohaematuria and pelvic congestion symptoms, should be carefully investigated for evidence of meso aortic left renal vein compression. A good number of our colleagues do not believe in the existence of the nutcracker syndrome and send these patients in a long pilgrimage in search of someone who can help them to get relief to their pain. New and improved imaging techniques can assist in the diagnosis but retrograde reno-gonadal phlebography and renocaval gradient are the most reliable diagnostic tools. Results: Among an assortment of treatment techniques, renal vein transposition and endovenous stenting were the two most commonly used procedures. There are no long term studies on renal vein stenting in children and young adults. Its use in these cases should be carefully considered. The nutcracker syndrome may present with pelvic congestion symptoms and its diagnosis missed. The patient's age, severity of symptoms and haemo dynamic renal studies should guide the treatment. Conclusion: An increased awareness of the existence of the nutcracker syndrome may prevent many unfortunate undiagnosed women from spending many months and often years of suffering.

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Renal hypothermia achieved by in situ cold saline perfusion in robotic partial nephrectomy for tumor in a solitary kidney: initial experience

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2013.01035 ◽

2013 ◽

Vol 33 (9) ◽

pp. 1035-1037

Author(s):

Bo YANG ◽

Lin-hui WANG ◽

Hui-qing WANG ◽

Fei GUO ◽

Hua-mao YE ◽

...

Keyword(s):

Partial Nephrectomy ◽

Solitary Kidney ◽

Robotic Partial Nephrectomy ◽

Initial Experience ◽

Cold Saline ◽

Renal Hypothermia

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Current results of left gonadal vein transposition to treat Nutcracker Syndrome

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.03.003 ◽

2021 ◽

Author(s):

Anaïs Debucquois ◽

Lucie Salomon du Mont ◽

Wilfried Bertho ◽

Adrien Kaladji ◽

Olivier Hartung ◽

...

Keyword(s):

Nutcracker Syndrome ◽

Gonadal Vein

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Nutcracker Syndrome with Pelvic Congestion Treated by Balloon Angioplasty: Report of a Case

The Japanese Journal of Phlebology ◽

10.7134/phlebol.15-09 ◽

2016 ◽

Vol 27 (1) ◽

pp. 33-37

Author(s):

Norio Uchida

Keyword(s):

Balloon Angioplasty ◽

Nutcracker Syndrome ◽

Pelvic Congestion

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Using magnetic resonance phase-contrast velocity mapping for diagnosing pelvic congestion syndrome

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2010.010049 ◽

2011 ◽

Vol 26 (4) ◽

pp. 157-161 ◽

Cited By ~ 9

Author(s):

L Q Meneses ◽

S Uribe ◽

C Tejos ◽

M E Andía ◽

M Fava ◽

...

Keyword(s):

Magnetic Resonance ◽

Phase Contrast ◽

Clinical Suspicion ◽

The Other ◽

Invasive Procedures ◽

Velocity Mapping ◽

Pelvic Congestion Syndrome ◽

Gonadal Vein ◽

Diagnostic Criterion ◽

Pelvic Congestion

Objective To evaluate phase-contrast velocity mapping (PCVM) as a diagnostic tool for pelvic congestion syndrome and comparing this approach with direct venography. Method We prospectively include nine women with clinical suspicion of pelvic congestion syndrome during a six-month period. All patients underwent a magnetic resonance phase-contrast scan before a direct venography. We considered a case of pelvic congestion syndrome when the PCVM showed a retrograde or slow (less than 5 cm/second) flow in any gonadal vein. This criterion was compared with the standard diagnostic criterion observed from a direct venography. Results Using direct venography we found 14 abnormal veins and all of them were correctly identified by the PCVM. The other four veins were found to be normal by the direct venography. However, two of them (the same patient) were abnormal in the PCVM, even though this patient had the classical symptoms of pelvic congestion syndrome. Conclusion PCVM is a useful tool for diagnosing pelvic contrast syndrome and can avoid invasive procedures such as direct venography.

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Imaging of Type I Retroaortic Left Renal Vein & Nutcracker Syndrome

10.20944/preprints202201.0190.v1 ◽

2022 ◽

Author(s):

Giovanni Fontanella ◽

Simona Borrelli ◽

Umberto Dello Iacono ◽

Barbara Brogna

Keyword(s):

Left Renal Vein ◽

Venous Hypertension ◽

Point Of View ◽

Type I ◽

Nutcracker Syndrome ◽

Renal Veins ◽

Gross Hematuria ◽

Renal Venous Hypertension ◽

Symptoms And Signs ◽

Pelvic Congestion

Retroaortic left renal veins are an often overlooked, but no so rare anatomic anomaly that might cause a few aspecific symptoms and signs, especially flank or inguinal pain, microscopic or even gross hematuria; in the vast majority of cases it is, thought, totally asymptomatic. The nutcracker syndrome that might arise in the case of RLRV is mainly due to the re- duced space between aorta and the vertebral body and the consequent compression on the venal rein; this might in turn cause upstream hypertension, hematuria, varicocele, pain. The compression of RLRV leads to hematuria because of renal venous hypertension, consequent left renal congestion. This upstream venous congestion might result, in some cases, in left-sided varicocele in men and pelvic congestion syndrome in women. From a radiologic point of view, the presence of RLRV and the precise reporting its subtypes is mandatory.

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