title: Transposition of the left renal vein for treatment of the nutcracker phenomenon: long-term follow-up.
abstract: OBJECTIVE
  To assess the therapeutic value of left renal vein transposition for treatment of the nutcracker phenomenon in long-term follow-up.
  
  
  METHODS
  Eight patients (4 women and 4 men) between 23 and 58 years old (mean 39.1) underwent transposition of the left renal vein for treatment of the nutcracker phenomenon associated with recurrent gross hematuria and flank pain. The postoperative follow-up was 41 to 136 months (mean 66.4).
  
  
  RESULTS
  No perioperative complications were encountered. The postoperative complications comprised deep vein thrombosis (n = 1), retroperitoneal hematoma necessitating surgical revision (n = 1), and paralytic ileus that resolved with conservative management (n = 1). One patient underwent laparotomy for treatment of mechanical ileus due to adhesions 4 years after the initial surgery. In 7 of 8 patients, transposition of the left renal vein efficiently relieved the symptoms related to the nutcracker phenomenon. In 1 patient, the hematuria persisted despite postoperative normalization of the pressure gradient between the left renal vein and the inferior vena cava.
  
  
  CONCLUSIONS
  Transposition of the left renal vein is an efficient surgical approach for the treatment of the nutcracker phenomenon and is associated with an acceptable risk of complications. However, rare cases may be encountered in which the shunted connections between the renal veins and the collecting system are so matured that, despite removal of the obstruction of the renal venous backflow, gross hematuria may persist.
authors.affiliation: Department of Urology, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: Gianluca
authors.initials: G
authors.lastname: D'Elia
authors.forename: Christian
authors.initials: C
authors.lastname: Hampel
authors.forename: Stefan
authors.initials: S
authors.lastname: Dahms
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000150:complications / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D012008:Recurrence; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D013577:Syndrome; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects