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07:54
Use of a Hanging-weight System for Isolated Renal Artery Occlusion
Published on: July 19, 2011
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Surgical Options and Outcomes for Renal Vein Entrapment
Gabrielle Schweitzer1, Georges Jreij1, Eleanor Dunlap2
1Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Vascular and Endovascular Surgery
|May 4, 2025
Summary
Surgical correction of nutcracker syndrome (NCS), a condition causing left renal vein (LRV) compression, effectively resolves or improves symptoms in most patients. Autotransplantation (AT) showed the best outcomes, while bovine pericardial neoconduit reconstruction had high complication rates.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Diagnostics
Background:
- Nutcracker syndrome (NCS) is characterized by left renal vein (LRV) compression between the superior mesenteric artery and aorta.
- Symptomatic NCS can cause significant flank or abdominal pain, predominantly affecting young females.
Purpose of the Study:
- To evaluate the outcomes of surgical correction for symptomatic nutcracker syndrome (NCS).
- To compare the efficacy and complication rates of different surgical techniques for NCS.
Main Methods:
- Retrospective review of 53 patients undergoing surgical correction for NCS.
- Preoperative assessment included venography and intravascular ultrasound (IVUS).
- Surgical procedures included renal vein transposition (RVT), autotransplantation (AT), and gonadal vein transposition (GVT).
Main Results:
- NCS patients were predominantly female (98%), with a mean age of 33.6 years.
- Preoperative IVUS revealed a mean LRV stenosis of 74%.
- Symptom resolution or improvement was reported in 79% of patients post-surgery, with 100% good outcomes after AT, 79% after RVT, and 50% after GVT.
Conclusions:
- Algorithm-based surgical management of NCS provides symptom relief or improvement in the majority of patients.
- Autotransplantation (AT) demonstrated superior outcomes compared to RVT and GVT.
- Renal vein reconstruction using bovine pericardial neoconduit is linked to a high incidence of vascular complications.
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