[MSB-31] Treatment of Nutcracker Syndrome: Outcomes with Left Renal Vein Transposition and Stenting

This study aimed to share our experiences and outcomes with left renal vein (LRV) transposition and endovascular stenting in treating Nutcracker syndrome.

Data of 20 female Nutcracker syndrome patients (mean age: 24 years) who underwent LRV transposition (n=15) or stenting (n=5) between July 2019 and June 2024 were retrospectively reviewed. Primary endpoints were morbidity and mortality. Secondary endpoints included late complications, patency, freedom from reintervention, and resolution of symptoms.

There were no major complications or mortality after either procedure. The most common signs and symptoms associated with LRV entrapment were left flank pain (100%, n=20), proteinuria (88%, n=15), and hematuria (47%, n=9). After both procedures, classical symptoms resolved in 89.5% (n=17) of patients for left flank pain, 57.8% (n=11) for proteinuria, and 82.3% (n=15) for hematuria. Four patients required reintervention [three after LRV transposition (two for occlusion and one for stenosis) and one after stenting (occlusion)]. The one-year primary patency rate was 87%, and the primary assisted patency rate was 100%. One-year primary patency rates were 91% for the transposition group and 75% for the stent group. The one-year freedom from reintervention was 83%.

Both procedures can be used as primary treatments and have their advantages. This study shows that both methods are safe and effective.