Treatment of nutcracker syndrome is controversial, with a wide array of therapeutic options. First described in 1937, the classic nutcracker syndrome (NCS) refers to the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta. 1. Introduction. Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature. described the abdominal aorta and the SMA as the two arms of a ânutcrackerâ that can potentially compress the left renal vein. The role of renal autotransplantation in treatment of nutcracker syndrome. Parnham AP, Low A, Finch P, Perlman D, Thomas MA: Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome. Several treatment options have been described to relieve associated symptoms. 1996, 78:25-28. The nutcracker syndrome managed by autotransplantation. Surgical approaches reported include venolysis and anterior nephropexy, renal vein bypass or interposition grafting, renocaval reimplantation, and autotransplantation. Most reports consist of small case series, and long-term results are limited. Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery, where it courses in the fork formed at the bifurcation of these arteries. 1 While the mainstay of treatment remains surgery, which is supported by good long-term outcomes, LRV stenting is an emerging alternative to open repair. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. Chuang CK, Chu SH, Lai PC. Left renal vein (LRV) entrapment, also known as nutcracker phenomenon if it is asymptomatic, is characterized by abnormality of outflow from the LRV into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) stenosis. Neppala P, Chau HS, Sood D, Berumen J, Mekeel KL. Left renal vein entrapment syndrome, also known as nutcracker syndrome, involves compression of the left renal vein and can present with abdominopelvic pain, hematuria, and symptoms of pelvic congestion syndrome. To report our experience with renal autotransplantation in treatment of gross hema-turia caused by nutcracker Syndrome (NCS). Left renal vein entrapment syndrome, characterized by the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the abdominal aorta was first described in 1950. 7. described the abdominal aorta and the SMA as the two arms of a ânutcrackerâ that can potentially compress the left renal vein. Renal Autotransplantation for Nutcracker Kidney after Prior Right Nephrectomy. Nutcracker syndrome is a venous compression syndrome involving the left renal vein. Urology. Renal vein thrombosis is a fairly uncommon site for vascular occlusion when isolated to this location. a = Right renal vein, b = right-sided aorta, c = superior mesenteric artery, d = left-sided vena cava. Laparoscopic splenorenal venous bypass for nutcracker syndrome Benjamin I. Chung, MD, and Inderbir S. Gill, MD, Cleveland, Ohio Nutcracker syndrome is a rare entity caused by extrinsic compression on the left renal vein as it crosses between the Abstract Objective Although nutcracker syndrome (NS) is rare, patients presenting with symptoms or signs and anatomic compression of the left renal vein (LRV) can be considered for intervention. Nutcracker Syndrome Treatment Nutcracker syndrome treatments can vary based on your age, symptoms, and the severity of your condition. Left renal vein transposition for nutcracker syndrome. A diagnosis of varicocele rupture secondary to nutcracker phenomenon was made. 1 Chait et al. The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein). LRV entrapment divided into 2 types: anterior and posterior. 1 Chait et al. Introduction. title = "Left renal vein transposition for nutcracker syndrome", abstract = "Objective: Nutcracker syndrome, caused by compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, results in left renal and gonadal venous hypertension. Renal autotransplantation has been used in the management of renal vessel trauma, thrombosis, stenosis, and aneurysms. Nutcracker syndrome is an easily missed cause of hematuria in children. Between September 2005 and January 2008, four pa-tients of mean age 25.5 years (range: 23-28) with gross hematuria were diagnosed to have NCS. 6. 2020 Feb 1;86(2):e88-e89. BEYOND BALLET: NUTCRACKER SYNDROME MANAGED WITH RENAL AUTO- TRANSPLANTATION IN AN 18-YEAR-OLD WOMAN. Left renal vein entrapment syndrome, characterized by the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the abdominal aorta was first described in 1950. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. Br J Urol. The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Nutcracker syndrome (NCS) is a rare condition that can be manifested with hematuria, flank pain, pelvic varicosities, or chronic pelvic congestion related to left renal vein (LRV) compression. 1. Journal of Vascular Surgery, 2009. Per riportare la nostra esperienza con autotrapianto renale in trattamento di ematuria lordo causata da schiaccianoci Syndrome (NCS). The nutcracker syndrome, first reported in 1950, is said to occur when the nutcracker phenomenon is accompanied by clinical symptoms including chronic abdominal pain and haematuria [ 1 ]. (A) Axial CT of the abdomen with contrast and (B) coronal reconstruction demonstrating the inverted nutcracker syndrome. FIGURE 1. It has also been advocated for ureteral avulsion, urothelial malignancy, renal calculus disease, renal tumor, renal trauma, retroperitoneal fibrosis, and nutcracker syndrome . Renal nutcracker syndrome is the venous entrapment caused by compression of the left renal vein between the aorta and superior mesen-teric artery (SMA). Historically, pediatric and adolescent patients with mild symptoms of nutcracker syndrome were simply observed while those with more severe symptoms underwent left renal vein transposition. Magnetic resonance angiography (MRA) followed. Introduction. Entrapment of the left renal vein between the aorta and superior mesenteric artery can cause renal venous hypertension, resulting in renal vein and left gonadal vein varices. The nutcracker syndrome managed by autotransplantation. Objective To study the pathophysiology of the nutcracker syndrome and to describe a new method of treatment.. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. The nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein (LRV) between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. Neste MG, Narasimhan DL, Belcher KK. J Urol. One month later, he underwent retroperitoneal laparoscopic donor nephrectomy and subsequent renal autotransplantation into the left iliac fossa. 1. Open surgery, specifically LRV transposition, has been the mainstay of treatment, but in the past few years, LRV stenting has emerged as a less invasive alternative without sufficient evidence to support it. ... Renal autotransplantation: transfer of a kidney from its original location into the body to another location to prevent [en.wikipedia.org] 1982;20:365-369. Xu D(1), Liu Y, Gao Y, Zhang L, Wang J, Che J, Zhu Y. Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature Am Surg. Surgical options for the treatment of nutcracker syndrome include left renal vein transposi-tion, gonadal vein transposition, renocaval bypass, and renal autotransplantation. Intended for healthcare professionals Nutcracker syndrome is one of the many unfortunate consequences of our bipedal lifestyle. Abstract. 3-7 Stewart BH, Reiman G. Left renal venous hypertension ânutcrackerâ syndrome managed by direct renocaval reimplantation. Scrotal hematoma and marked dilation of left renal vein and left gonadal vein were revealed by computed tomography. autotransplantation of the right kidney would offer the best chance of surgical correction of symptoms. Manju Kalra The arterial studies were normal, however, the venous images showed compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) consistent with the diagnosis of nutcracker syndrome (Fig 1). Nutcracker syndrome is defined as left renal vein compression with concomitant clinical symptoms that include flank pain and hematuria. 8. It is a rare and commonly overlooked condition. J Urol. The clinical syndrome caused by impingement of the left renal vein (LRV) between the superior mesenteric artery (SMA) and abdominal aorta has been termed Nutcracker syndrome [].Although often asymptomatic, it may result in varicocele, ovarian vein syndrome, haematuria, flank or abdominal pain, LRV hypertension, and pelviureteral varices. Renal ultrasound revealed a âswollenâ left kidney. Chin JL, Kloth D, Pautler SE, Mulligan M: Renal autotransplantation for the loin pain-hematuria syndrome: long-term followup of 26 cases. 1998, 150:1232-1235. Skip to main content. The small intestines hang like baggy sausages off the branched stems of the superior mesenteric artery (SMA), and in some individuals, the SMA compresses the left renal vein against the aorta. Despite modern imaging modalities, the diagnosis of nutcracker syndrome is difficult. It is an uncommon, although possibly underdiagnosed, condition that may lead to serious complications if left untreated.
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