Stenting as first option for endovascular treatment of malignant superior vena cava syndrome objective. Endovascular and open management of renal vein nutcracker. 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. Nutcracker syndrome symptoms, treatment, causes, surgery. It should not be confused with with superior mesenteric artery syndrome aka wilkie syndrome which although also a superior mesenteric artery compression disorder, the sma compresses the. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. We reported a case of successful endovascular stenting of the left renal vein for nutcracker syndrome. Endovascular stenting to manage svc syndrome of the 208 stents inserted in our series of patients, 182 were firsttime placements and the remaining 26 nine immediate and 25 in followup were second coaxial stents inserted to treat unexpected complications. A 21yearold chinese woman was admitted with a sevenmonth history of unilateral severe hematuria. Management of renal nutcracker syndrome by retroperitoneal. An unusual course of segmental renal artery displays a. Nutcracker syndrome, or mesoaortic compression of the left. 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. Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome.
Your upmc doctor will discuss each option with you. Is a complex of clinical symptoms that results from nutcracker phenomenon ncp ncs can be found any time from childhood to old age, with a relatively high prevalence in young and middleaged adults no difference between the sexes. Stent migration is relatively common after endovascular stenting. Vascular tos usually occurs in young patients and athletes who are involved in repetitive overhead motion, such as swimming or baseball. Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures.
Jan 01, 2000 the clinical syndrome caused by impingement of the left renal vein lrv between the superior mesenteric artery sma and abdominal aorta has been termed nutcracker syndrome. Although both terms are clinically equivalent, the latter is used for patients who are manifesting the characteristic clinical symptoms of the disorder 2. Nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein lrv between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the lrv and dilatation of the distal portion. We report a case of migration of a laparoscopically. Oct 27, 2009 nutcracker syndrome ncs is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery sma. She had surgery, which is left renal vein transposition, where. 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. Endovascular stent placement for nutcracker phenomenon ios. Surgical and endovascular interventions for nutcracker syndrome. She was diagnosed in april 2009 after over a year and a half of trying to figure out what was wrong. An unusual course of segmental renal artery displays a rare. It was described for the first time in 1996 by neste et al.
Endovascular stenting as the first step in the overall. The small intestines hang like baggy sausages off the branched stems of the superior mesenteric artery sma, and in some individuals, the sma. It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein. Open, laparoscopic, and endovascular techniques have been developed to decrease the venous outflow obstruction of the lrv. New york, 8 march 2006 for patients with lifethreatening aneurysms of the carotid artery in the neck, a minimally invasive stentgrafting technique can be just as effective as traditional open surgery, but with faster recovery and fewer complications, according to a study in the march journal of vascular surgery. Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. Although the nutcracker syndrome represents a form of vascular compression, no previous reports have appeared in the vascular surgical literature. Nutcracker syndrome servier phlebolymphologyservier. My daughter has nutcracker syndrome testicular disorders. 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. Nutcracker syndrome treated by endovascular stenting of the left.
Superior vena cava syndrome in thoracic malignancies. Sep 20, 2016 nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein lrv between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the lrv and dilatation of the distal portion. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome. Once they have reached the brain, the endovascular neurosurgeon can use a series of platinum coils or a gluelike substance to repair problems in arteries and veins within the head. There are many modalities of treatment of nutcracker syndrome.
Extravascular stent management for migration of left renal. If hematuria is not present it is termed nutcracker phenomenon. The nutcracker syndrome ncs is a rare cause of haematuria. In this report, we are presenting a case of rare variant. After a successful endovascular stenting and a 6month period of antiplatelet and anticoagulant therapy, the patient returned to stable health. Endovascular stenting to manage svc syndrome vascular and interventional radiology original research. Renal vein stenting for nutcracker syndrome endovascular today. Mesoaortic compression of the left renal vein the so. We finally went to mayo clinic and she was diagnosed there. Renal vein stenting for nutcracker syndrome endovascular.
We report a rare cause if a 12yearold boy who presented with a history of frequent intermittent episodes of painless constant haematuria. Endovascular management of nutcracker syndrome after. Percutaneous angioplasty and stenting for symptomatic lrv compression and the nutcracker syndrome is an excellent alternative to more invasive approaches. The most common treatments for nutcracker syndrome are. Although often asymptomatic, it may result in varicocele, ovarian vein syndrome, haematuria, flank or abdominal pain, lrv hypertension, and pelviureteral varices. The nutcracker syndrome ncs is a described as a mesoaortic compression of the left renal vein between the abdominal aorta and the superior mesenteric artery together with hematuria. Additionally, this method can be successfully used in the treatment of posterior nutcracker syndrome. Considering the process neednt to transplant lrv or to insert entovascular stent, extravascular stenting is a feasible, safe option for the nutcracker syndrome. Mesoaortic compression of the left renal vein the socalled.
Nutcracker syndrome treated by endovascular stenting of the left renal vein. Endovascular neurosurgery barrow neurological institute. We report a case of nutcracker syndrome diagnosed with 3dimensional computed tomography angiography 3d cta. Nutcracker syndrome with pelvic congestion treated by balloon. Ultimately it may be associated with substantial morbidity and even lifethreatening events. Ecr 2019 c2443 nutcracker phenomenon and syndrome epos. Endovascular angioplasty with stenting cas treatment. Some people may not have symptoms, while others develop severe and. Nutcracker syndrome is one of the many unfortunate consequences of our bipedal lifestyle. Results are encouraging at followup periods beyond two. The clinical syndrome caused by impingement of the left renal vein lrv between the superior mesenteric artery sma and abdominal aorta has been termed nutcracker syndrome.
We reported a teaching case with ncs who underwent endovascular. Endovascular treatment of nutcracker syndrome journal of. 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. Looking at it from a transverse plane both sma and aorta. Results are encouraging at followup periods up to 2 years. We present a case of a 54yearold female with chronic lower abdominal pain radiating to the left thigh of 4 years in duration. Although it is in its infancy, endovascular therapy for nutcracker syndrome is a viable option that may circumvent more invasive procedures. Minimally invasive treatment using a stentgraft to repair the carotid. Terms in this set 69 nutcracker syndrome is the result of extrinsic compression of what. Aug 31, 2017 minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Jun 22, 2017 endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome.
The endovascular therapy of the nutcracker syndrome ncs. Endovascular treatment of nutcracker syndrome sciencedirect. Nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in males and females alike. Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Nutcracker syndrome is an entity resulting from left renal vein. Endoprostheses were inserted in cancer patients with superior vena cava syndrome to assess their effectiveness as. Nutcracker syndrome and hypertension radiology case. 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. It embraces an extended nonpathognomonic spectrum of symptoms that imply a difficult diagnosis. Nutcracker syndrome is the term used to describe the patient with clinical symptoms of entrapment of the left renal vein between the aorta and the superior mesenteric artery. Nowadays, with the development of imaging techniques, color doppler sonogram and 3d cta are replacing venography for the diagnosis of nutcracker. This case illustrates the features of nutcracker syndrome, also known as renal vein entrapment syndrome, and an uncommon cause of secondary hypertension.
This case report describes a patient diagnosed with nutcracker syndrome who was treated successfully by embolization of the ovarian vein and insertion of a stent. Application of extravascular stenting for nutcracker. Endovascular treatment of nutcracker syndrome scielo. I reached out on instagram and found many others with this disease. The mainstay of therapy is stent placement covered or uncovered, selfexpanding or balloon expandable. Vascular thoracic outlet syndrome vtos is categorized as disorders of the upper extremity, which are caused by compression of the brachial plexus and subclavian artery or vein by bony, soft tissue or muscular anomalies as they emerge from the thoracic outlet. Nutcracker phenomenon and nutcracker syndrome are sometimes used interchangeably in literatures. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the. Endovascular stenting has shown promising longterm resolution of symptoms but can be complicated by stent migration or thrombosis. Pelvic congestion syndrome, which is a cause of chronic pelvic pain in women, may be due to nutcracker syndrome. Robotassisted laparoscopic extravascular stent for. The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper. Your surgeon may choose to treat your nutcracker syndrome using a stent a small mesh tube to hold your left renal vein open and allow for proper blood flow.
We recently treated a young woman incapacitated by left flank pain and hematuria with a new external stenting procedure, which relieved the nutcracker syndrome. 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. 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 surgery with venous stent placement has gained. Stenting as first option for endovascular treatment of. Current management approach for left renal vein entrapment.
Extravascular stent management for migration of left renal vein. 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. 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. Although nutcracker syndrome ns is rare, patients presenting with symptoms or signs and anatomic compression of the left renal vein lrv can be considered for intervention. Carotid blowout syndrome emergent endovascular management by. Nutcracker syndrome is an entity resulting from left renal vein compression by. Endovascular stenting for treatment of nutcracker syndrome. It was described for the first time in 1996 by nesteet al. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. It can be easily overlooked, and should be considered in young men or women with symptoms of extended duration. 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. 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.
Endovascular interventions have become the treatment of choice for most cases of cbos. Endovascular stent placement for nutcracker phenomenon. Although surgical repair has been the standard of care, more recently endovascular stenting of the renal vein has been proposed. Minimal invasive management includes both endovascular stenting and extravascular stenting 1, 2. Results are encouraging at followup periods beyond 2 years. Minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Feezor, md facs assistant professor of surgery university of florida. 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 had been confirmed by conventional venography until recent years. Renal nutcracker syndrome genetic and rare diseases. Surgical and endovascular interventions for nutcracker.
Posterior nutcracker syndrome with left renal vein. In addition, embolization of the pseudoaneurysm before or after stenting to cover the neck of the pseudoaneurysm may be needed. A 52yearold woman who had a history of hematuria two years previously was admitted to another hospital for treatment of recurrent hematuria. Endovascular treatment of nutcracker syndrome request pdf. Nutcracker syndrome ncs is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery sma. Placement of left renal venous stent for nutcracker syndrome. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration. Laparoscopic extravascular stent placement has shown promising results with the potential to avoid these complications. 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. In one of the largest series of endovascular stents, 75 young patients received venous stents for.
Endovascular and open management of renal vein nutcracker syndrome robert j. The small intestines hang like baggy sausages off the branched stems of the superior mesenteric artery sma, and in some individuals, the sma compresses the left renal vein against the aorta. Patients of nutcracker syndrome having the only symptom of significant varicocele are recommended for surgery from our experience. Endovascular neurosurgery involves passing small instruments through an artery in the groin and navigating them to blood vessels in the brain. She had surgery, which is left renal vein transposition, where her symptoms resolved for about two weeks.
Dec 01, 20 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. Jul 14, 2017 nutcracker syndrome is one of the many unfortunate consequences of our bipedal lifestyle. 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. The superior vena cava syndrome svcs comprises various symptoms due to occlusion of the svc, which can be easily obstructed by pathological conditions eg, lung cancer, due to the low internal venous pressure within rigid structures of the thorax trachea, right bronchus, aorta. Vascular thoracic outlet syndrome vascular surgery. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or. In addition, embolization of the pseudoaneurysm before or after stenting to. Left renal vein lrv compression by the aorta and the superior mesenteric artery sma leading to symptoms of hematuria or left flank pain has been classically described as nutcracker syndrome ncs 1, 2. Nutcracker syndrome with pelvic congestion treated by.
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