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Endovascular stenting for the nutcracker phenomenon
R Chiesa1, A Anzuini, E M Marone
1Department of Vascular Surgery, Vita e Salute University, San Raffaele Hospital, Milan, Italy. roberto.chiesa@hsr.it
Summary
Stent implantation effectively treats left renal vein (LRV) entrapment, or nutcracker phenomenon, resolving symptoms like hematuria. This endovascular approach offers a safe and valuable alternative to surgery.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Left renal vein (LRV) entrapment, commonly termed nutcracker phenomenon, involves compression of the vein between the superior mesenteric artery and aorta.
- This condition can lead to significant patient morbidity, including hematuria and flank pain.
Observation:
- A 17-year-old male presented with gross hematuria and left flank pain.
- Diagnostic imaging, specifically magnetic resonance angiography, confirmed LRV compression.
- Initial stent placement with a Wallstent was insufficient, necessitating a second procedure.
Findings:
- Successful stent implantation using a Memotherm stent restored adequate luminal flow in the LRV.
- Post-procedure CT angiography at 6 months demonstrated LRV patency.
- The patient remained asymptomatic with complete resolution of hematuria at 12 months.
Implications:
- Endovascular stenting is a safe and effective treatment for nutcracker phenomenon.
- This minimally invasive technique can reduce the morbidity associated with surgical interventions.
- Stent implantation presents a viable therapeutic option for managing symptomatic LRV entrapment.