Endovascular treatment of nutcracker syndrome : a case report

Background: The "nutcracker" syndrome is most commonly caused by arterial compression of the left renal vein between the superior mesenteric artery and the aorta. As a consequence venous blood pressure increases within the renal pelvis, ureter and gonadal veins. This compression syndrome may be treated by endovascular stent implantation into the left renal vein. Case report: A 20 year old female patient was referred to us, suffering from pain in her left side, gross proteinuria and the suspicion of "nutcracker" syndrome. Symptoms were present for the last 3 years. Angio MRI was performed and confirmed compression of the left renal vein between the aorta and the superior mesenteric artery. The patient was qualified for endovascular treatment. A self expandable metallic stent, diameter 16 x 40 mm was implanted into the left renal vein. Control venography confirmed good placement of the stent and a good immediate hemodynamic effect of the procedure. The patient remains symptom free in a 14 month follow up period. Conclusions: At present, endovascular stenting seems to be the method of choice for the treatment of the nutcracker syndrome.