title: Transposition of the left renal vein for the treatment of nutcracker syndrome in children: a short-term experience.
abstract: BACKGROUND
  Nutcracker syndrome is caused by compression of the left renal vein between the superior mesenteric artery and the aorta. Invasive surgical intervention for this pathologic entity is controversial, particularly in the pediatric population. We aim to describe our early clinical and operative experience with such patients.
  
  
  METHODS
  We report 3 cases of pediatric patients undergoing successful left renal vein transposition for the treatment of nutcracker syndrome.
  
  
  RESULTS
  All 3 patients were female (age 9-17 years) and presented with a mean of 11.7 months of abdominal or left flank pain requiring chronic narcotic analgesia. Initial clinical presentations were associated with either hematuria or proteinuria. Diagnosis of nutcracker syndrome was supported in each case by an elevated renocaval pressure gradient and/or axial imaging demonstrating mesoaortic compression of the left renal vein. All patients underwent open surgical repair, which included left renal vein transposition, liberation of the ligament of Treitz and associated adhesions, as well as excision of periaortic nodal tissue (mean hospital length of stay 5.7 days). After mean follow-up of 13 months, all patients report complete resolution of symptoms and hematuria/proteinuria.
  
  
  CONCLUSIONS
  Transposition of the left renal vein is a safe and effective treatment for nutcracker syndrome in appropriately selected pediatric patients. Further experience and long-term follow-up are warranted to better evaluate the sustained efficacy of this procedure in this unique patient population.
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Brant W
authors.initials: BW
authors.lastname: Ullery
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Nathan K
authors.initials: NK
authors.lastname: Itoga
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA. Electronic address: mwmell@stanford.edu.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Mell
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D002648:Child; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D010690:Phlebography / Q000379:methods; D011507:Proteinuria / Q000209:etiology; D059228:Renal Nutcracker Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures