Aortomegaly Causing Nutcracker Syndrome and Pelvic Congestion Syndrome

AbstractThe authors present an uncommon cause of pelvic congestion syndrome (PCS) secondary to anterior nutcracker syndrome, which was caused by aortomegaly. Positional flank and pelvic pain was the only presenting feature with no renal dysfunction. Early and significant decompression of left renal vein (LRV) via left ovarian vein resulted in preserved renal function with symptomatic pelvic varices. Endovascular management by left ovarian vein coiling and LRV stenting was done. They briefly review the etiopathology, imaging, treatment rationale, and management options for nutcracker and PCS.

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Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽

10.1024/0301-1526/a000538 ◽

2016 ◽

Vol 45 (4) ◽

pp. 275-282 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantin Beier ◽

Alexander von Weymarn ◽

Jürg Traber

Keyword(s):

Varicose Veins ◽

Left Renal Vein ◽

Standing Position ◽

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Compression Syndrome ◽

Abstract Knowledge ◽

Increased Risk ◽

Definition Of ◽

Pelvic Congestion

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

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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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Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03192-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Akihito Yamamoto ◽

Seiryu Kamoi ◽

Shunji Suzuki

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Renal Vein ◽

Spontaneous Rupture ◽

Left Renal Vein ◽

Vena Cava ◽

Vascular Network ◽

Retroperitoneal Hematoma ◽

Nutcracker Syndrome ◽

Ovarian Vein

Abstract Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

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Pelvic Congestion Syndrome Secondary to a Circumaortic Left Renal Vein

The Journal of Pediatrics ◽

10.1016/j.jpeds.2020.01.005 ◽

2020 ◽

Vol 220 ◽

pp. 261-262

Author(s):

Verónica Alonso ◽

Alberto Sánchez-Abuín ◽

José Javier Velasco ◽

José Manuel Marugán de Miguelsanz

Keyword(s):

Renal Vein ◽

Left Renal Vein ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Unusual causes of left renal vein compression along its course: MDCT findings in patients with nutcracker and pelvic congestion syndrome

Surgical and Radiologic Anatomy ◽

10.1007/s00276-009-0548-1 ◽

2009 ◽

Vol 32 (4) ◽

pp. 323-327 ◽

Cited By ~ 6

Author(s):

Devrim Karaosmanoğlu ◽

Musturay Karcaaltincaba ◽

Deniz Akata ◽

Mustafa Ozmen

Keyword(s):

Renal Vein ◽

Left Renal Vein ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of Nutcracker syndrome

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.10.112 ◽

2011 ◽

Vol 53 (4) ◽

pp. 1100-1103 ◽

Cited By ~ 9

Author(s):

Donald T. Baril ◽

Patricio Polanco ◽

Michel S. Makaroun ◽

Rabih A. Chaer

Keyword(s):

Renal Vein ◽

Left Renal Vein ◽

Nutcracker Syndrome ◽

Endovascular Management ◽

Recurrent Stenosis

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A therapeutic option in nutcracker syndrome and ovarian vein insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355512474253 ◽

2013 ◽

Vol 29 (3) ◽

pp. 144-149 ◽

Cited By ~ 3

Author(s):

V Bekou ◽

C Zollikofer ◽

N Nieuwkamp ◽

A Von Weymarn ◽

S Duewell ◽

...

Keyword(s):

Renal Vein ◽

Varicose Veins ◽

Therapeutic Option ◽

Left Renal Vein ◽

Balloon Dilation ◽

Nutcracker Syndrome ◽

Ovarian Vein ◽

Pelvic Vein ◽

Collateral Vein ◽

Vein Insufficiency

Objectives: The nutcracker syndrome (NS) may lead to insufficient perirenal collaterals as well as incompetence of the left ovarian vein with consecutive ovarian vein insufficiency. Methods: A female patient with NS and severe genital varicosis was treated with dilation of the renal vein and coiling of a left perirenal collateral vein feeding an insufficient left ovarian vein (LOV) with pelvic vein varicosity. Results: In re-evaluation 18 month later with left renal vein (LRV) and LOV phlebography, a widely patent LRV was found. The embolized LRV to LOV collateral was occluded. However, left hypogastric phlebography showed incompetent branches of the left hypogastric vein feeding the genital varicose veins. These were successfully embolized with coils and the genital varicosity decreased on follow-up. Conclusions: In our patient a combined therapeutic approach with balloon dilation of the NS and embolization of the genital varicose veins by left hypogastric vein coil was performed.

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