2002 Volume 13 Issue 3 Pages 217-222
Nutcracker syndrome (left renal vein (LRV) entrapment syndrome) refers to compression of the LRV between the aorta and the superior mesenteric artery (SMA). This anatomical condition results in renal venous hypertension and macrohematuria. In this paper we report two cases of nutcracker syndrome treated with LRV transposition.
Patient #1: A 24-year-old male suffered from a 9-year history of severe left flank pain and macroscopic hematuria. Ultrasonography revealed a narrow segment of the LRV between the aorta and the SMA. Venous velocity in the narrow segment was 160 cm/sec. Computerized tomography (CT) revealed a compressed LRV between the aorta and the SMA and a highly dilated distal part of the LRV. The nutcracker distance between the aorta and the SMA was 4mm. Selective left renal phlebography revealed a compressed part at a junction between the LRV and the inferior vena cava (IVC). The pressure gradient between the LRV and the IVC was 6.8cmH2O. Transposition of the LRV, 3cm caudal in relation to an original site, was carried out. Postoperatively the left flank pain and macroscopic hematuria disappeared. The pressure gradient between the LRV and the IVC lowered to 2.4cmH2O.
Patient #2: A 16-year-old male suffered from a 5-year history of macroscopic hematuria. It worsened after exercise, which then had to be restricted. Ultrasonography and CT revealed a compressed LRV between the aorta and the SMA. The nutcracker distance between the two arteries was 4 mm by ultrasonography and 6 mm by CT. The pressure gradient between the LRV and the IVC was 5.4cmH2O. Caudal transposition of the LRV was carried out. His hematuria did not change much after a short period of alleviation. Postoperative phlebography revealed occlusion of the anastomosis. After several months, his hematuria became progressively milder.
