Anterior Renal Nutcracker Syndrome in an Older Adult Treated with Endovascular Stenting

Anterior nutcracker syndrome occurs when the left renal vein is compressed between the abdominal aorta and the superior mesenteric artery. A 71-year-old woman presented to hospital with sudden-onset intense lower abdominal pain with radiation to the left flank region. Her lab work was significant for hemoglobin 9.8 G/DL (11.7 - 15.0 G/DL), creatinine 1.52 mg/dL (0.50 - 1.10 mg/dL) and microscopic examination of the urine contained red blood cells. Computed tomography scan of the abdomen & pelvis with contrast showed left renal vein narrowing as it crosses between the superior mesenteric artery and the aorta, consistent with nutcracker sydnrome. The patient underwent a venogram study alongside intravascular ultrasound and was treated with left renal vein wall stenting and venoplasty. She tolerated the procedure well and was successfully discharged on daily anticoagulation with rivaroxaban for one month with close follow-up.