Endovascular stenting for iliac and renal vein obstructions peter gloviczki, md roberts professor and chair, emeritus, division of vascular and endovascular surgery, mayo clinic, rochester, mn, usa january 1921, 2017 paris, france. Endovascular treatment by stenting was proposed and is not very invasive, but followup is too short to establish the role of this technique in the management of the nutcracker syndrome. Imaging findings and clinical features of abdominal. At the upmc heart and vascular institute, our surgeons in the division of vascular surgery are experts in treating nutcracker syndrome using the latest techniques. Endovascular stenting for treatment of nutcracker syndrome.
Doppler ultrasound, computed tomography angiography and selective renal vein phlebography revealed the compression of the left renal vein by the abdominal aorta. It was described for the first time in 1996 by nesteet al. Nutcracker syndrome, first reported in 1972, is characterized by hematuria and back pain caused by increased pressure in the lrv as a result of compression between the aorta and the sma. Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. Imaging findings and clinical features of abdominal vascular. Although endovascular stenting is an attractive option, it is not without complications. Several treatment options have been described to relieve associated symptoms. The nutcracker syndrome ncs is the clinical equivalent of. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration. Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta, leading to symptoms of hematuria and left flank pain. Pitfalls and bailouts of endovascular stenting for iliac. Endovascular surgery is a form of intervention that is becoming ever more popular among specialists for treatment of vascular lesions, including nutcracker syndrome. Renal vein stenting for nutcracker syndrome endovascular. It occurs when arteries compress the left renal kidney vein, often causing intermittent hematuria blood in the urine.
Nutcracker syndrome ncs is a rare clinical condition that occurs when the left renal vein lrv experiences venous outflow obstruction secondary to external vascular compression, most often between the aorta and superior mesenteric artery sma. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. Hematuria is likely due to varices in the collecting system secondary to renal venous hypertension. A simplified approach with gonadal vein transposition posted on june 12, 2016 june 12, 2016 by docpark the patient is a young woman in her twenties who developed severe right sided abdominal and back pain about 4 months prior to. Endovascular stenting for nutcracker syndrome nutcracker syndrome ncs, or renal vein entrapment syndrome, is a rare and easily overlooked condition. Posts about nutcracker syndrome written by docpark. Diagnosis of pns is challenging, as symptoms are variable and not specific. Carotid artery angioplasty with stenting cas is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Posterior nutcracker syndrome in a child journal of. It can be easily overlooked, and should be considered in young men or women with symptoms of extended duration.
It could make you more likely to have a dvt deep vein. We report the efficacy and safety of endovascular stenting for nutcracker syndrome at longterm followup. Vascular and endovascular surgery overview mayo clinic. Nutcracker syndrome ncs is a rare entity defined by the symptomatic hypertension of the left renal vein lrv compressed in the majority of cases between the superior mesenteric artery and the aorta.
Jul 24, 2015 nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. It was described for the first time in 1996 by neste et al. Results of endovascular treatment for patients with nutcracker syndrome. The nutcracker syndrome should be considered as an uncommon cause of haematuria, particularly when a left sided varicocoele is also present. Nutcracker syndrome is a rare diagnosis and may manifest in unusual ways. Jun 22, 2017 renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. Nutcracker syndrome is a clinical entity leading to renal venous hypertension due to extrinsic compression of the left renal vein by the superior.
Some people may not have symptoms, while others develop severe and. Doppler ultrasound, computed tomography ct and selective left renal vein phlebography are useful to. Current management approach for left renal vein entrapment. While traditionally treated with open surgery, the last several years have seen increased utilization of an endovascular approach through stenting of the lrv. Typically, a selfexpanding nitinol or stainless steel stent is used. Patient is a 43 year old woman who had been having bouts of severe left sided abdominal pain for several years with worsening episodes of nausea and vomiting resulting in several visits to the emergency room. However, it is estimated to be relatively more common in females and usually presents in the 3rd or 4th decade of life. Scholbach t 2007 from the nutcrackerphenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs. Author links open overlay panel young erben md a peter gloviczki md a manju kalra mbbs a haraldur bjarnason md b nanette r. Thrombosis, stent migration, fracture and restenosis are the complications of the endovascular stenting but they are rare. Superior mesenteric artery syndrome is an uncommon cause of high gastrointestinal tract obstruction, and should be suspected when endoscopic examination does not reveal an intrinsic obstruction. Venous stents may lead to fibromuscular hyperplasia, embolization and proximal migration which may be fatal 20. Extravascular stent management for migration of left renal. A simplified approach with gonadal vein transposition posted on june 12, 2016 june 12, 2016 by docpark the patient is a young woman in her twenties who developed severe right sided abdominal and back pain about 4 months prior to presentation associated with bouts of bloody urine.
Lymphedema, carotid dissection, venous disorder, carotid artery stenosis, mesenteric ischemia, nutcracker syndrome, marfan. Hybrid intervention for treatment of the nutcracker syndrome. The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa with some imagination appear to be a nutcracker crushing a nut the renal vein. Venous stents may lead to fibromuscular hyperplasia, embolization and proximal migration which may be fatal. Percutaneous angioplasty and stenting for symptomatic lrv compression and the nutcracker syndrome is an excellent alternative to more invasive approaches. Materials and methods we retrospectively evaluated the endovascular stenting experience with 61 patients with a median age of 26 years. The nutcracker syndrome is a vascular disorder, but the signs and symptoms are mainly urological or gynecological.
When the left renal vein is compressed between the aorta and the superior mesenteric artery it causes anterior nutcracker syndrome. Surgical treatment of posterior nutcracker syndrome journal. Maythurner syndrome, also known as iliac vein compression syndrome or cocketts syndrome, affects two blood vessels that go to your legs. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. Posterior nutcracker syndrome occurs when a retroaortic left renal vein becomes compressed between the abdominal aorta and the lumbar spine. Surgical and endovascular interventions for nutcracker. Endovascular stenting is an alternative treatment option. This can lead to renal venous hypertension, resulting in rupture of thinwalled veins into. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome lu tian1, shanwen chen2, gaoyue zhang3, hongkun zhang1, wei jin1 and ming li1 abstract background.
Scholbach t 2007 from the nutcracker phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs. Endovascular stenting of the renal vein has been reported for nutcracker syndrome with a promising safety and efficacy profile. The patient was diagnosed with nutcracker syndrome and underwent endovascular stent placement. Your surgeons discuss with you all suitable treatment options, which may include traditional open surgery and minimally invasive techniques. The mild nutcracker syndrome can be witnessed in children during the changes their body undergoes due to growth. Despite potential serious consequences, diagnosing ncs is often challenging, circuitous and commonly delayed. Varicose veins doctors and departments mayo clinic. Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of cbs. The exact prevalence of nutcracker syndrome is unknown, likely because of the variable presenting features.
Common treatments for nutcracker syndrome include stenting, surgery, and routine urine tests. The purpose of this study was to evaluate late results of lrv transposition and identify risk factors affecting outcomes. Nutcracker syndrome servier phlebolymphologyservier. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. Read surgical and endovascular interventions for nutcracker syndrome, seminars in vascular surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Endovascular treatment of nutcracker syndrome sciencedirect. This can lead to obstruction of flow into the inferior vena cava and secondary left renal venous hypertension. Nov 22, 2017 although endovascular stenting is an attractive option, it is not without complications. A novel hybrid left renal vein transposition and endovascular. Following are the common symptoms that have been studied in the nutcracker syndrome. Nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in males and females alike. We report a case of migration of a laparoscopically. Surgical treatment of posterior nutcracker syndrome. Endovascular angioplasty with stenting cas treatment.
Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the. We take a team approach to diagnose your condition and design a treatment plan thats. Conclusion nutcracker syndrome is a rare diagnosis and may manifest in unusual ways. Renal vein compression syndromes are rare causes of hematuria and can be divided into anterior and posterior nutcracker syndrome. Therapeutic options are debated, and either conservative, open, or endovascular approaches have been advocated as both safe and.
Nutcracker syndrome, a rare cause of haematuria, is caused by a compression of the lrv between the aa and the sma. Jul 14, 2017 posts about nutcracker syndrome written by docpark. Popliteal artery aneurysm doctors and departments mayo clinic. Though lrv transposition and now lrv stenting are commonly employed methods for treatment of nutcracker syndrome, judicious management of ncs should take into consideration patients age, severity, and chronicity of symptoms along with current lack of data regarding longterm outcomes of stent placement. Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric artery sma and aorta, although other variations can exist 1. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Endovascular treatment of carotid blowout syndrome mayo clinic. Superior mesenteric artery syndrome and the nutcracker. A case report of a young girl with recurrent hematuria. At the upmc heart and vascular institute, our surgeons in the division of vascular surgery are experts in treating nutcracker syndrome. Thrombectomy, aneurysm surgery, carotid angioplasty and stenting, endovascular reconstruction, thoracic aortic aneurysm surgery, varicose vein.
It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. We describe a case of a 28yearold man who presented with microscopic hematuria, leftsided flank pain, and testicular swelling. Endovascular stenting for nutcracker syndrome sciencedirect. Although it is in its infancy, endovascular therapy for nutcracker syndrome is a viable option that may circumvent more invasive procedures. Posterior nutcracker syndrome pns is a rare condition due to left renal vein lrv hypertension, caused by compression of the lrv between the vertebral column and the abdominal aorta. Although open surgical approaches remain the treatment of choice, endovascular stenting has been used successfully. Doppler ultrasound, computed tomography ct and selective left renal vein phlebography are useful to confirm. Endovascular stenting for nutcracker syndrome kuokang feng, chunyang huang, chenyuan hsiao, tsunghsing lee, tzuting kuo, chunche shih, chiaopo hsu division of cardiovascular surgery, department of surgery, taipei veterans general hospital and national yangming university school of medicine, taipei, taiwan, roc.
The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. Renal nutcracker syndrome genetic and rare diseases. Imaging findings and clinical features of abdominal vascular compression syndromes. It can be preferred to open surgery because of the long period of renal congestion, additional anastomoses and extensive dissection requirement of the open surgery. Mayo clinic has one of the largest and most experienced practices in the united states, with campuses in arizona, florida and minnesota. 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. It is characterized by external compression of the outflow from the left renal vein lrv into the inferior vena cava ivc. Endovascular treatment of nutcracker syndrome is a new tool for treating the syndrome offering the advantages of being less invasive and causing less morbidity and mortality. Nutcracker syndrome ncs, which is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, leads to a series of clinical symptoms including. Endovascular stent placement for the treatment of nutcracker.
Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. Nutcracker syndrome ncs is caused by compression of left renal vein lrv, usually between the aorta and the superior mesenteric artery sma. 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. Nutcracker syndrome is an entity resulting from left renal vein compression by. Left renal vein transposition for nutcracker syndrome. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or. Learn more about treatment options for this aneurysm that occurs in the wall of an artery located behind the knee joint. Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures. Diagnosis and treatment of the nutcracker syndrome. Venous stenting nonthrombotic iliac vein lesions nivl maythurner syndrome.
Minimally invasive treatments for venous compression syndromes. Embolization therapy, sclerotherapy, carotid angioplasty and stenting, endovascular aneurysm repair, carotid artery dis. Mayo clinic vascular and endovascular surgeons develop and use advanced diagnostic techniques and surgical treatments, such as balloon angioplasty and stenting, bypass surgery, and carotid endarterectomy. Nutcracker syndrome, caused by compression of the left renal vein lrv between the superior mesenteric artery and the aorta, results in left renal and gonadal venous hypertension. Results of endovascular treatment for patients with. Nov 06, 2014 endovascular stenting is an alternative treatment option. Another clinical study has shown that nutcracker syndrome is a frequent finding in varicoceleaffected patients and possibly, nutcracker syndrome should be routinely excluded as a possible cause of varicocele and pelvic congestion. This article describes the typical imaging findings and clinical features that are associated with four abdominal vascular compression syndromes. In women, the hypertension in the left gonadal vein can also cause increased pain during menses. To retrospectively assess the therapeutic value of endovascular stenting for treatment of the nutcracker syndrome ncs in longterm followup and to explore the selection of the size of stents in chinese patients with ncs. Policha a, lamparello p, sadek m, berland t, maldonado t 2016 endovascular treatment of nutcracker syndrome. Nutcracker syndrome, also called renal nutcracker syndrome is a rare vascular condition.
Erben is a vascular surgeon in jacksonville, florida and is affiliated with one hospital. The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. Nutcracker syndrome is an easily missed cause of hematuria in children. Endovascular stenting for nutcracker syndrome article pdf available in journal of the chinese medical association 766 april 20 with 143 reads how we measure reads. Surgical intervention for nutcracker syndrome is the preferred approach in children. Endovascular stenting for the nutcracker phenomenon is safe and effective and may represent a valuable approach for lessening the morbidity of. Popliteal artery aneurysm doctors and departments mayo. Nutcracker syndrome results from compression of the left renal vein lrv between the aorta and the superior mesenteric artery sma.
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