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Updated: Jan 24, 2026
Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
Salvage Renal Autotransplant Following Previous Renal Vein Stenting in Nutcracker Syndrome
Talal Al-Qaoud1, Natalie Bath, Robert Redfield
1From the Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, Wisconsin, USA.
Objectives:
Nutcracker syndrome is rare, and a proportion of patients with this syndrome continue to have intractable pain and symptoms. Due to the heterogeneity of patients' chief complaints and symptoms, the surgeon's preferred approach may be inherently different but is of paramount importance to the outcome.
Materials And Methods:
We present 4 cases in which renal autotransplant with extraction and ligation of previously placed gonadal coils was performed following previously attempted renal vein stenting or combined renal vein transposition followed by renal vein stenting.
Results:
Autotransplant resulted in flank pain resolution with improvement in symptoms associated with pelvic congestion syndrome.
Conclusions:
The approach to such cases requires meticulous and adequate vena cava exposure, with preparation for potential caval reconstruction. No firm inferences can be made from such a small series; however, we believe in renal autotransplant as first-line therapy, and failure after an initial renal vein stent should be salvaged by renal autotransplant over further endovascular attempts.
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