title: Recurrent hematuria caused by nutcracker syndrome.
abstract: A 26-year-old woman presented to the emergency department complaining of left flank pain, and proteinuria and hematuria were detected during urinalysis. A renal ultrasound did not reveal any disorder, and after performing a computed tomography angiography scan, compression of the left renal vein between the superior mesenteric artery and the aorta was seen. This compression is known as Nutcracker syndrome. From among the different treatment options available, it was decided, with patient consensus, to use open surgical management, performing a transposition of the left renal vein to a more distal level in the inferior vena cava. The immediate postoperative care progressed without complications and the symptoms resolved; after 1 year of surveillance, the patient continues to be asymptomatic. Nutcracker syndrome is a rare phenomenon, with few cases described. There are different therapeutic options for the treatment of Nutcracker syndrome, such as open surgery, endovascular treatment, or conservative treatment; because of the low prevalence of this syndrome, there are no sufficiently large series at present or with the necessary long-term surveillance to decide on the most suitable treatment. Distal transposition of the left renal vein in the inferior cava vein has proved to offer good long-term results, and this option offers a higher chance of resolution without the need for as many postsurgery controls as would be required with endovascular treatment.
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain. Electronic address: pdelcanto@hotmail.es.
authors: Pablo
authors: P
authors: Del Canto Peruyera
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
authors: Fernando
authors: F
authors: Vaquero Lorenzo
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
authors: Manuel Javier
authors: MJ
authors: Vallina-Victorero Vazquez
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
authors: Andrés
authors: A
authors: Alvarez Salgado
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
authors: María
authors: M
authors: Vicente Santiago
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
authors: Marta
authors: M
authors: Botas Velasco
authors: Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
authors: Luis Javier
authors: LJ
authors: Alvarez Fernandez
mesh_terms: D000328:Adult; D005260:Female; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D012008:Recurrence; D059228:Renal Nutcracker Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery