Results of endovascular treatment for patients with nutcracker syndrome

To retrospectively assess the therapeutic value of endovascular stenting for treatment of the nutcracker syndrome (NCS) in long-term follow-up and to explore the selection of the size of stents in Chinese patients with NCS.

From January 2004 to August 2010, 30 patients (two women and 28 men) between 13 and 32 years old (mean, 18.2) who were diagnosed with NCS were admitted for endovascular treatment. Each patient received one self-expanding metallic stent (14-mm diameter, 60-mm long) in the compressed portion of the left renal vein during the operation, and three patients with severe left-sided varicoceles received left gonadal vein embolization. The postoperative follow-up was 12 to 80 months (median, 36.0 months).

The diameters at the ostium of left renal vein measured by the ultrasonic examination before treatment were 11.8 ± 1.8 mm. Technical success of operation was achieved in all patients. No perioperative complications occurred. Two cases of stent migration were found at 12 months: both stents prolapsed into the inferior vena cava, with uneventful follow-up (49 and 56 months, respectively). At 1-month follow-up, patients improved, including two patients who had persistent but less microscopic hematuria than before treatment. The clinical symptoms related to NCS almost disappeared at 3 months after the treatment. All stents were patent at the duplex scan examination, without restenosis, and no secondary recurrence of the symptoms occurred at the end of the follow-up.

Endovascular treatment is a safe, effective, and very minimally invasive technique that provides good long-term patency rates for patients with NCS, and under the premise morphologic measurements, 14-mm-diameter, 60-mm-long self-expanding stents should be first considered for Chinese patients with NCS.