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Recurrent hematuria caused by nutcracker syndrome
Pablo Del Canto Peruyera1, Fernando Vaquero Lorenzo1, Manuel Javier Vallina-Victorero Vazquez1
1Department of Angiology and Vascular and Endovascular Surgery, Cabueñes Hospital, Asturias, Spain.
Annals of Vascular Surgery
|December 11, 2013
Summary
Nutcracker syndrome, a rare condition causing left renal vein compression, was successfully treated in a young woman using open surgical transposition. This surgical approach resolved her symptoms and offers promising long-term results.
Area of Science:
- Urology
- Vascular Surgery
- Radiology
Background:
- Nutcracker syndrome is a rare vascular condition characterized by the compression of the left renal vein.
- Diagnosis often involves advanced imaging like computed tomography angiography.
- Symptomatic presentation typically includes flank pain, hematuria, and proteinuria.
Observation:
- A 26-year-old woman presented with left flank pain, hematuria, and proteinuria.
- Renal ultrasound was inconclusive, but CT angiography revealed left renal vein compression between the superior mesenteric artery and aorta.
- The patient underwent open surgical management with left renal vein transposition.
Findings:
- The surgical transposition of the left renal vein to the inferior vena cava resulted in complete symptom resolution.
- Postoperative care was uncomplicated, and the patient remained asymptomatic at 1-year follow-up.
- Distal transposition of the left renal vein demonstrates good long-term efficacy.
Implications:
- Open surgical transposition of the left renal vein is an effective treatment for Nutcracker syndrome.
- This surgical option may offer a higher resolution rate and fewer post-surgery controls compared to endovascular treatments.
- Further research with long-term surveillance is needed to definitively establish the optimal treatment strategy for Nutcracker syndrome due to its rarity.
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