NUTCRACKER SYNDROME TREATED BY ENDOVASCULAR STENTING OF THE LEFT RENAL VEIN

Abstract

We describe endovascular stenting of the left renal vein to treat Nutcracker syndrome accompanied by gross hematuria. A 26-year-old woman with a history of hematuria and left flank pain was admitted to another hospital in January 2009. She was referred to our hospital in August 2010 for further investigation and treatment for suspected Nutcracker syndrome based on her medical history and the recurrent gross hematuria. Computed tomography (CT) imaging revealed compression of the left renal vein between the aorta and the superior mesenteric artery and cystoscopy revealed bloody urine from the left ureteric orifice. Ureteroscopy revealed diffuse bleeding from the renal pelvic mucosa. The cytodiagnosis of urine was Class II. She developed left flank pain and further recurrent hematuria in July 2011 and sought active treatment by stenting at our hospital. After we obtained the approval of the Ethical Review Board in our institution, we treated by endovascular stenting of the left renal vein. The venous phase of selective renal angiography during the procedure revealed dilation of the mid-renal vein with delayed flow into the inferior vena cava and tortuous dilated collateral vessels. Two E-LUMINEXX Vascular Stents (12×40 mm) were deployed at the stenotic site of the left renal vein via the right femoral vein. This strategy improved the stenosis and collateral vessels. No significant postoperative adverse events developed other than dull back pain that disappeared after a few days, and the patient was discharged on postoperative day 4. CT findings three months after the procedure confirmed resolution of the left renal vein compression. Six months post-procedure, the patient had no left flank pain or further hematuria.