scholarly journals Imaging of Type I Retroaortic Left Renal Vein & Nutcracker Syndrome

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.

Nutcracker Syndrome: Case Report on the Management of Recurrent Stenosis After Stenting

2017 ◽  
Vol 51 (4) ◽  
pp. 203-208 ◽  
Author(s):  
Natasha Hansraj ◽  
Abdul Hamdi ◽  
Ali Khalifeh ◽  
Eric Wise ◽  
Rajabrata Sarkar ◽  
...  
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Stent Migration ◽  
Venous Hypertension ◽  
Intractable Pain ◽  
Nutcracker Syndrome ◽  
Extrinsic Compression ◽  
Vein Bypass ◽  
Renal Venous Hypertension

Nutcracker syndrome is a clinical entity leading to renal venous hypertension due to extrinsic compression of the left renal vein by the superior mesenteric artery. Current surgical therapy involves placement of an oversized renal vein stent with partial protrusion into the inferior vena cava (IVC) to relieve stenosis and prevent stent migration. Here, we present a patient with intractable pain and hematuria secondary to nutcracker syndrome who underwent left renal vein stent placement and developed recurrent symptoms due to flow-limiting kinking at the left renal hilum, with partial obstruction of the IVC from pseudointimal hyperplasia. This was treated with stent excision and construction of a left neorenal vein bypass. Thus, given these complications, we should perhaps revisit the recommendations for oversizing of the stent.

scholarly journals Left Renal Vein Thrombus and Pulmonary Thromboembolism Caused by Nutcracker Syndrome: a Case Report

2021 ◽  
Author(s):  
Kanta Hori ◽  
Shota Yamamoto ◽  
Maki Kosukegawa ◽  
Noboru Yamashita ◽  
Yuichiro Shinno
Keyword(s):  
Case Report ◽  
Renal Vein ◽  
Pulmonary Thromboembolism ◽  
Case Reports ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
Venous Hypertension ◽  
Nutcracker Syndrome ◽  
Case Presentation ◽  
Renal Venous Hypertension

Abstract Background: Nutcracker syndrome (NCS) refers to compression of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA), which results in renal venous hypertension and its resultant clinical manifestations. Left renal vein thrombus (LRVT) complicating NCS is relatively rare. To the best of our knowledge, there are only four case reports of LRVT complicating NCS. Furthermore, there are no reports of pulmonary thromboembolism (PTE) caused by NCS. Herein, we describe a rare case of NCS causing LRVT and PTE and its clinical management. Case Presentation: A 40-year-old man was admitted to our hospital with acute left flank pain. Computed tomography angiography (CTA) revealed compression of the LRV between the aorta and the SMA with an LRVT. Furthermore, CTA revealed bilateral PTE. Rivaroxaban was administered as an anticoagulant. Twenty days after initiation, CTA revealed complete resolution of PTE and LRVT, and repeat CTA at 3 and 6 months showed no recurrence. Conclusions: This case report demonstrates that NSC may be a possible cause of LRVT and PTE. We review the reported cases of NCS complicated by LRVT and discuss the imaging modalities for NCS.

scholarly journals Patient with Nutcracker Syndrome Treated by Spiral Vein Graft Bypass

2021 ◽  
Author(s):  
drmohammad alşalaldeh ◽  
Ali Vefa Özcan ◽  
Gökhan Yiğit TANRISEVER
Keyword(s):  
Abdominal Pain ◽  
Abdominal Aorta ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Left Renal Vein ◽  
Venous Hypertension ◽  
Vascular Pathology ◽  
Left Renal Artery ◽  
Nutcracker Syndrome ◽  
Renal Venous Hypertension

Abstract Nutcracker syndrome is a vascular pathology result from compressing the left renal vein between the superior mesenteric artery (SMA) and abdominal aorta. Patients usually complain of abdominal pain and symptoms from renal venous hypertension. In this case, a 32-year-old male patient presented with chronic abdominal pain for two years. İnvestigations showed the left renal artery compressed between SMA and abdominal aorta. He was operated on by using a spiral saphenous vein graft. The operation was done successfully with no complications.

The desperate plea of women with the nutcracker syndrome

Phlebologie ◽  
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.

scholarly journals Nutcracker Syndrome: A Rare Cause of Hematuria

2006 ◽  
Vol 6 ◽  
pp. 745-746 ◽  
Author(s):  
Emmanuel C. Gorospe ◽  
Michael O. Aigbe
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Renal Veins ◽  
Collecting System

Nutcracker syndrome is the compression of the left renal vein between the aorta and superior mesenteric artery. It is a rare cause of hematuria which results from the rupture of congested renal veins into the collecting system.

scholarly journals Aortomegaly Causing Nutcracker Syndrome and Pelvic Congestion Syndrome

2018 ◽  
Vol 02 (03) ◽  
pp. 197-200
Author(s):  
Krantikumar Rathod ◽  
Amit Sahu ◽  
Bhavesh Popat ◽  
Hemant Deshmukh
Keyword(s):  
Renal Function ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Ovarian Vein ◽  
Endovascular Management ◽  
Management Options ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Varices ◽  
Pelvic Congestion

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.

scholarly journals A Case of the Nutcracker Syndrome Developed after Delivery

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Koji Tsumura ◽  
Kanae Yoshida ◽  
Sachi Yamamoto ◽  
Sayuri Takahashi ◽  
Katsuyuki Iida ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Ureteral Orifice ◽  
Nutcracker Syndrome ◽  
Gross Hematuria ◽  
First Report ◽  
Enhanced Computed Tomography

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.

scholarly journals Case report of gross hematuria in the nutcracker syndrome resolved by renocaval reimplantation

2016 ◽  
Vol 73 (12) ◽  
pp. 1178-1180
Author(s):  
Igor Banzic ◽  
Nikola Fatic ◽  
Sinisa Pejkic ◽  
Lazar Davidovic ◽  
Milos Sladojevic ◽  
...  
Keyword(s):  
Case Report ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Nutcracker Syndrome ◽  
Gross Hematuria ◽  
Extrinsic Compression ◽  
Clinical Center ◽  
Urethral Orifice ◽  
Ventral Aorta

Introduction. Nutcracker syndrome is defined as a set of signs and symptoms secondary to compression of the left renal vein (LRV) in the acute anatomic angle between the aorta and its superior mesenteric branch. Case report. A 38-year old woman with asymptomatic and ?idiopathic? gross hematuria came to the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade. Hematuria was documented by cystoscopy and was found to be unilateral, located to the left urethral orifice. The contrast-enhanced multidetector computed tomography (MDCT) scan showed a stenotic LRV due to the extrinsic compression in the angle formed by the ventral aorta and superior mesenteric artery (MSA), with a jet of contrast through the lumen. Considering the negative investigations for more common causes of hematuria, its incapacitating nature, and above mentioned imaging findings suggestive of the nutcracker syndrome, an indication for the open surgical correction of the LRV entrapment was established. The patient underwent reimplantation of the LRV into the more distal inferior vena cava (IVC), to relocate it out of the constrictive aortomesenteric space. Intraoperative findings were notable for blood flow turbulence in the LRV and hypertrophy of its tributaries, which were ligated. We presented the first published case in the Serbian literature on nutcracker syndrome with hematuria resolved by renocaval reimplantation. Conclusion. This case report demonstrates that renocaval reimplantation, as the open surgery technique, could be the adequate method for resolving gross hematuria in patients with nutcracker syndrome.

Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula

1983 ◽  
Vol 59 (6) ◽  
pp. 1019-1030 ◽  
Author(s):  
Edward H. Oldfield ◽  
Giovanni Di Chiro ◽  
Eugene A. Quindlen ◽  
Kenneth G. Rieth ◽  
John L. Doppman
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Venous Hypertension ◽  
Current Therapy ◽  
Type I ◽  
Content Type ◽  
Symptoms And Signs ◽  
Extensive Surgery ◽  
Fine Print

✓ As demonstrated by selective spinal cord arteriography, over 80% of spinal cord arteriovenous malformations (AVM's) occupy a predominantly extramedullary position. Current therapy frequently requires surgical stripping of the long dorsal intradural vessel(s) from the underlying spinal cord over many cord segments. The authors report six patients with a dural arteriovenous fistula fed by a cluster of abnormal epidural arteries. These vessels, which surrounded and were embedded into the dural covering of a thoracic nerve root, drained into a long sinuous intrathecal paramedullary vein(s). The angiographic and surgical appearance of the intradural component of these lesions was identical to that of lesions previously classified as Type I AVM's of the spinal cord. All patients had symptoms and signs of myelopathy. In five patients, surgery was limited to coagulation and excision of the extradural vessels and division of the intradural arterialized vein. Progressive improvement began within days following surgery. No residual abnormality was demonstrated by postoperative selective spinal cord arteriography, which was performed in all five patients. The findings support those of Kendall and Logue, that surgery restricted to elimination of the arteriovenous fistula at the intervertebral foramen is curative, and that more extensive surgery is unnecessary for this subgroup of AVM's of the spinal cord. These lesions comprise a sizable percent of all spinal AVM's. Resolution of myelopathy in these patients supports the hypothesis that venous hypertension causes chronic progressive myelopathy.

Transperitoneal Laparoscopic Left Gonadal Vein Ligation Can Be the Right Treatment Option for Pelvic Congestion Symptoms Secondary to Nutcracker Syndrome

Vascular ◽  
2007 ◽  
Vol 15 (4) ◽  
pp. 238-240 ◽  
Author(s):  
Alistair Rogers ◽  
Andrew Beech ◽  
Bruce Braithwaite
Keyword(s):  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Venous Flow ◽  
Nutcracker Phenomenon ◽  
Gonadal Vein ◽  
Multiparous Women ◽  
The Right ◽  
Laparoscopic Sterilization ◽  
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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