Endovascular treatment of the nutcracker syndrome: report of two cases

The nutcracker syndrome (NS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta. Clinically, it presents with flank pain, hematuria, and symptoms of pelvic venous congestion. Several surgical techniques have been described including left renal vein (LRV) transposition, autotransplantation, LRV bypass, superior mesenteric artery (SMA) transposition, gonadocaval bypass and nephrectomy. More recently, endovascular stenting of the renal vein has been proposed. We present two patients with NS who were successfully managed endovascularly, providing satisfactory mid-term clinical and imaging results.