Endovascular Treatment of Nutcracker Syndrome.
BACKGROUND
Nutcracker syndrome, or mesoaortic compression of the left renal vein (LRV), with associated symptoms related to venous hypertension in the left kidney, is a rare entity that may result in severe symptoms requiring operative intervention. We report on 3 patients who presented with nutcracker syndrome, including one patient with a circumaortic LRV resulting in posterior nutcracker syndrome, who underwent successful endovascular treatment with renal vein stenting. A review of existing literature on endovascular management of nutcracker syndrome follows.


METHODS
Three women (age range 28-43 years) presented with symptoms and imaging studies consistent with nutcracker syndrome. Symptoms included pelvic and flank pain in all 3 patients, and episodes of hematuria in 2 patients. Imaging studies demonstrated compression of the LRV between the superior mesenteric artery and aorta in 2 of the patients. The third patient was noted to have a circumaortic LRV.


RESULTS
All 3 patients underwent venography and LRV stenting. Stents included a 12 × 40 mm self-expanding nitinol stent, 14 × 60 mm WALLSTENT, and 16 × 40 mm WALLSTENT. All patients were placed on clopidogrel postoperatively. The duration of follow-up ranged from 6 to 27 months. At follow-up, all 3 patients reported significant symptomatic improvement, and duplex ultrasonography demonstrated stent patency in all.


CONCLUSIONS
Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Results are encouraging at follow-up periods beyond 2 years.
Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
Aleksandra
A
Policha
Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
Patrick
P
Lamparello
Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
Mikel
M
Sadek
Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
Todd
T
Berland
Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY. Electronic address: thomas.maldonado@nyumc.org.
Thomas
T
Maldonado
D000328:Adult; D000497:Alloys; D000077144:Clopidogrel; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D010690:Phlebography; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D012079:Renal Circulation; D059228:Renal Nutcracker Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
D000497:Alloys; D010975:Platelet Aggregation Inhibitors; C013616:nitinol; D000077144:Clopidogrel; D013988:Ticlopidine