Nutcracker Syndrome: A Review of the Current Literature
Main Article Content
Abstract
Nutcracker Syndrome is a rare condition secondary to either compression of the left renal vein in its normal anatomic position by the superior mesenteric artery and aorta, or rarely, when the left renal vein is in a retroaortic position, compressed between the aorta and the spine. Left renal vein compression varies widely in presentation and severity, ranging from asymptomatic imaging findings, to chronic pelvic or flank pain. While left renal vein transposition remains the most common management modality, there is growing acceptance for other surgical interventions as well as endovascular treatments–particularly stenting. However, there remains a scarcity of evidence for these less invasive techniques. We conduct a review of the recent literature and discuss the diagnosis and current management strategies for nutcracker syndrome. We also revisit a unique case of nutcracker syndrome in a female patient with a history of chronic pelvic pain and venous congestion wherein transposition of the left renal vein resulted in complete resolution of her symptoms.
Article Details
How to Cite
DERIEUX, Jaclyn; OBED, Dina; CASEY, Kevin.
Nutcracker Syndrome: A Review of the Current Literature.
Medical Research Archives, [S.l.], v. 10, n. 9, sep. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3122>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v10i9.3122.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. St. Hilaire C, Paisley M, Greene J, Casey KM. Left renal vein transposition for posterior nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2021;7(2):243-246. doi:10.1016/j.jvscit.2021.02.016
2. Macedo GL, Santos MA, Sarris AB, Gomes RZ. Diagnosis and treatment of the Nutcracker syndrome: a review of the last 10 years. Jornal Vascular Brasileiro. 2018;17(3):220-228. doi:10.1590/1677-5449.012417
3. Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An update on current diagnostic criteria and management guidelines. European Journal of Vascular and Endovascular Surgery. 2017;53(6):886-894. doi:10.1016/j.ejvs.2017.02.015
4. Chait J, Sen I, Kalra M. Nutcracker Syndrome: How to diagnose it and when/how should it be treated in the pelvic venous disease population. Techniques in Vascular and Interventional Radiology. 2021;24(1):100734. doi:10.1016/j.tvir.2021.100734
5.Kim KW, Cho JY, Kim SH, et al. Diagnostic value of computed tomographic findings of Nutcracker Syndrome: Correlation with renal venography and renocaval pressure gradients. European Journal of Radiology. 2011;80(3):648-654. doi:10.1016/j.ejrad.2010.08.044
6. de los Reyes T, Keefe DT, Rickard M, Lorenzo AJ. Diagnosis and therapeutic strategies for Nutcracker Syndrome. Current Opinion in Urology. 2020;31(2):135-137. doi:10.1097/mou.0000000000000831
7. Miró I, Serrano A, Pérez-Ardavín J, et al. Eighteen years of experience with pediatric nutcracker syndrome: The importance of the Conservative approach. Journal of Pediatric Urology. 2020;16(2). doi:10.1016/j.jpurol.2019.12.003
8. Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y. A systematic review on management of Nutcracker Syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2018;6(2):271-278. doi:10.1016/j.jvsv.2017.11.005
9. Park JH, Lee GH, Lee SM, et al. Posterior nutcracker syndrome – a systematic review. Vasa. 2018;47(1):23-29. doi:10.1024/0301-1526/a000670
10. Greenspan J, Szczerepa D, Trocha K, Rao A, Fluss G, Finlay D. A novel approach for the treatment of Nutcracker Syndrome: A case report. Annals of Vascular Surgery. 2022;79. doi:10.1016/j.avsg.2021.07.046
11. Debucquois A, Salomon du Mont L, Bertho W, Kaladji A, Hartung O, Rinckenbach S. Current results of left gonadal vein transposition to treat nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2021;9(6):1504-1509. doi:10.1016/j.jvsv.2021.03.003
12. Gilmore BF, Benrashid E, Geersen D, Shortell CK. Gonadal vein transposition is a safe and effective treatment of nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2021;9(3):712-719. doi:10.1016/j.jvsv.2020.09.002
13. White JV, Ryjewski C. A simplified surgical approach for left ovarian vein transposition for the treatment of pelvic venous disease from nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2021;7(3):411-414. doi:10.1016/j.jvscit.2021.05.008
14. Macedo GL, Santos MA, Sarris AB, Gomes RZ. Venous revascularization to treat posterior nutcracker syndrome by transposition of the left gonadal vein: case report. Jornal Vascular Brasileiro. 2019;18. doi:10.1590/1677-5449.190037
15. Zhang X, Wang S, Wei J. Prosthetic left renocaval bypass for posterior nutcracker syndrome. Indian Journal of Surgery. 2014;77(S1):103-105. doi:10.1007/s12262-014-1180-9
16. Chen S, Zhang H, Shi H, Tian L, Jin W, Li M. Endovascular stenting for treatment of nutcracker syndrome: Report of 61 cases with long-term followup. Journal of Urology. 2011;186(2):570-575. doi:10.1016/j.juro.2011.03.135
17. Avgerinos ED, Saadeddin Z, Humar R, et al. Outcomes of left renal vein stenting in patients with nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2019;7(6):853-859. doi:10.1016/j.jvsv.2019.06.016
18. Wu Z, Zheng X, He Y, et al. Stent migration after endovascular stenting in patients with nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2016;4(2):193-199. doi:10.1016/j.jvsv.2015.10.005
19. Bookwalter CA, VanBuren WM, Neisen MJ, Bjarnason H. Imaging appearance and nonsurgical management of pelvic venous congestion syndrome. RadioGraphics. 2019;39(2):596-608. doi:10.1148/rg.2019180159
20. Leal Monedero J, Zubicoa Ezpeleta S, Perrin M. Management of left renal vein compression in patients presenting left gonadal vein reflux. Phlebology: The Journal of Venous Disease. 2017;33(7):475-482. doi:10.1177/0268355517723992
21. Stawiarski K, Wosnitzer M, Erben Y. A novel hybrid left renal vein transposition and endovascular stenting technique for the treatment of posterior nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2017;3(3):142-145. doi:10.1016/j.jvscit.2017.04.003
22. Steinberg RL, Johnson BA, Garbens A, Cadeddu JA. Robotic assisted extravascular stent placement for Nutcracker phenomenon of the left renal vein: A case series. Journal of Robotic Surgery. 2020;14(5):781-788. doi:10.1007/s11701-020-01054-x
23. Lin JC, Ranasinghe B, Patel A, Rogers CG. Robot-assisted laparoscopic placement of extravascular stent for nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2020;6(3):346-347. doi:10.1016/j.jvscit.2020.03.013
24. Policha A, Lamparello P, Sadek M, Berland T, Maldonado T. Endovascular treatment of nutcracker syndrome. Annals of Vascular Surgery. 2016;36. doi:10.1016/j.avsg.2016.04.005
25. Guo YT, Wang H, Wang JP, Zhang B. Two-Year Follow-up on Laparoscopic Three-Dimensional Printed Extravascular Stent Placement for Posterior Nutcracker Syndrome. Chin Med J (Engl). 2018;131(23):2895-2896. doi:10.4103/0366-6999.246075
26. Belczak SQ, Coelho Neto F, de Araújo WJ, Godoy JM. Endovascular treatment of anterior nutcracker syndrome and pelvic varices in a patient with an anterior and a posterior renal vein. BMJ Case Reports. 2020;13(9). doi:10.1136/bcr-2020-235284
27. Cronan JC, Hawkins CM, Kennedy SS, Marshall KW, Rostad BS, Gill AE. Endovascular management of Nutcracker Syndrome in an adolescent patient population. Pediatric Radiology. 2021;51(8):1487-1496. doi:10.1007/s00247-021-04986-0
28. Chen Y, Xing J, Liu F. Left renal vein transposition is effective for posterior nutcracker syndrome. Int J Clin Exp Med. 2014;7(12):5925-5927. 2014 Dec 15.
2. Macedo GL, Santos MA, Sarris AB, Gomes RZ. Diagnosis and treatment of the Nutcracker syndrome: a review of the last 10 years. Jornal Vascular Brasileiro. 2018;17(3):220-228. doi:10.1590/1677-5449.012417
3. Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An update on current diagnostic criteria and management guidelines. European Journal of Vascular and Endovascular Surgery. 2017;53(6):886-894. doi:10.1016/j.ejvs.2017.02.015
4. Chait J, Sen I, Kalra M. Nutcracker Syndrome: How to diagnose it and when/how should it be treated in the pelvic venous disease population. Techniques in Vascular and Interventional Radiology. 2021;24(1):100734. doi:10.1016/j.tvir.2021.100734
5.Kim KW, Cho JY, Kim SH, et al. Diagnostic value of computed tomographic findings of Nutcracker Syndrome: Correlation with renal venography and renocaval pressure gradients. European Journal of Radiology. 2011;80(3):648-654. doi:10.1016/j.ejrad.2010.08.044
6. de los Reyes T, Keefe DT, Rickard M, Lorenzo AJ. Diagnosis and therapeutic strategies for Nutcracker Syndrome. Current Opinion in Urology. 2020;31(2):135-137. doi:10.1097/mou.0000000000000831
7. Miró I, Serrano A, Pérez-Ardavín J, et al. Eighteen years of experience with pediatric nutcracker syndrome: The importance of the Conservative approach. Journal of Pediatric Urology. 2020;16(2). doi:10.1016/j.jpurol.2019.12.003
8. Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y. A systematic review on management of Nutcracker Syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2018;6(2):271-278. doi:10.1016/j.jvsv.2017.11.005
9. Park JH, Lee GH, Lee SM, et al. Posterior nutcracker syndrome – a systematic review. Vasa. 2018;47(1):23-29. doi:10.1024/0301-1526/a000670
10. Greenspan J, Szczerepa D, Trocha K, Rao A, Fluss G, Finlay D. A novel approach for the treatment of Nutcracker Syndrome: A case report. Annals of Vascular Surgery. 2022;79. doi:10.1016/j.avsg.2021.07.046
11. Debucquois A, Salomon du Mont L, Bertho W, Kaladji A, Hartung O, Rinckenbach S. Current results of left gonadal vein transposition to treat nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2021;9(6):1504-1509. doi:10.1016/j.jvsv.2021.03.003
12. Gilmore BF, Benrashid E, Geersen D, Shortell CK. Gonadal vein transposition is a safe and effective treatment of nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2021;9(3):712-719. doi:10.1016/j.jvsv.2020.09.002
13. White JV, Ryjewski C. A simplified surgical approach for left ovarian vein transposition for the treatment of pelvic venous disease from nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2021;7(3):411-414. doi:10.1016/j.jvscit.2021.05.008
14. Macedo GL, Santos MA, Sarris AB, Gomes RZ. Venous revascularization to treat posterior nutcracker syndrome by transposition of the left gonadal vein: case report. Jornal Vascular Brasileiro. 2019;18. doi:10.1590/1677-5449.190037
15. Zhang X, Wang S, Wei J. Prosthetic left renocaval bypass for posterior nutcracker syndrome. Indian Journal of Surgery. 2014;77(S1):103-105. doi:10.1007/s12262-014-1180-9
16. Chen S, Zhang H, Shi H, Tian L, Jin W, Li M. Endovascular stenting for treatment of nutcracker syndrome: Report of 61 cases with long-term followup. Journal of Urology. 2011;186(2):570-575. doi:10.1016/j.juro.2011.03.135
17. Avgerinos ED, Saadeddin Z, Humar R, et al. Outcomes of left renal vein stenting in patients with nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2019;7(6):853-859. doi:10.1016/j.jvsv.2019.06.016
18. Wu Z, Zheng X, He Y, et al. Stent migration after endovascular stenting in patients with nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2016;4(2):193-199. doi:10.1016/j.jvsv.2015.10.005
19. Bookwalter CA, VanBuren WM, Neisen MJ, Bjarnason H. Imaging appearance and nonsurgical management of pelvic venous congestion syndrome. RadioGraphics. 2019;39(2):596-608. doi:10.1148/rg.2019180159
20. Leal Monedero J, Zubicoa Ezpeleta S, Perrin M. Management of left renal vein compression in patients presenting left gonadal vein reflux. Phlebology: The Journal of Venous Disease. 2017;33(7):475-482. doi:10.1177/0268355517723992
21. Stawiarski K, Wosnitzer M, Erben Y. A novel hybrid left renal vein transposition and endovascular stenting technique for the treatment of posterior nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2017;3(3):142-145. doi:10.1016/j.jvscit.2017.04.003
22. Steinberg RL, Johnson BA, Garbens A, Cadeddu JA. Robotic assisted extravascular stent placement for Nutcracker phenomenon of the left renal vein: A case series. Journal of Robotic Surgery. 2020;14(5):781-788. doi:10.1007/s11701-020-01054-x
23. Lin JC, Ranasinghe B, Patel A, Rogers CG. Robot-assisted laparoscopic placement of extravascular stent for nutcracker syndrome. Journal of Vascular Surgery Cases, Innovations and Techniques. 2020;6(3):346-347. doi:10.1016/j.jvscit.2020.03.013
24. Policha A, Lamparello P, Sadek M, Berland T, Maldonado T. Endovascular treatment of nutcracker syndrome. Annals of Vascular Surgery. 2016;36. doi:10.1016/j.avsg.2016.04.005
25. Guo YT, Wang H, Wang JP, Zhang B. Two-Year Follow-up on Laparoscopic Three-Dimensional Printed Extravascular Stent Placement for Posterior Nutcracker Syndrome. Chin Med J (Engl). 2018;131(23):2895-2896. doi:10.4103/0366-6999.246075
26. Belczak SQ, Coelho Neto F, de Araújo WJ, Godoy JM. Endovascular treatment of anterior nutcracker syndrome and pelvic varices in a patient with an anterior and a posterior renal vein. BMJ Case Reports. 2020;13(9). doi:10.1136/bcr-2020-235284
27. Cronan JC, Hawkins CM, Kennedy SS, Marshall KW, Rostad BS, Gill AE. Endovascular management of Nutcracker Syndrome in an adolescent patient population. Pediatric Radiology. 2021;51(8):1487-1496. doi:10.1007/s00247-021-04986-0
28. Chen Y, Xing J, Liu F. Left renal vein transposition is effective for posterior nutcracker syndrome. Int J Clin Exp Med. 2014;7(12):5925-5927. 2014 Dec 15.