Left Renal Vein Transposition for Posterior Nutcrackersyndrome
Cameron St. Hilaire, MD, Michael Paisley, MD, Justin Greene, MD, and Kevin M. Casey, MD, Santa Barbara, Calif
ABSTRACT
Nutcracker syndrome (NCS) is a rare cause of pelvic venous congestion syndrome and is secondary to either compression of the left renal vein in its normal anatomic position by the superior mesenteric artery and aorta or less commonly when the left renal vein is in a retroaortic position, compressed between the aorta and the spine. We herein present a unique case of NCS in a female patient with a history of chronic pelvic pain and venous congestion. We also review the literature and discuss the diagnostic modalities, differential diagnosis, and various open surgical and endovascular options for NCS. (J Vasc Surg Cases and Innovative Techniques 2021;7:243-6.)
Keywords: Posterior Nutcracker syndrome; Pelvic congestion; Left renal vein transposition
Nutcracker syndrome (NCS) can be divided into two types: anterior and posterior. The presentation can range from asymptomatic hematuria to symptomatic flank pain, pelvic congestion (females), varicocele enlargement (males), and renal vein thrombosis. Anterior NCS (aNCS) accounts for the majority of cases and is characterized by the left renal vein (LRV) in its normal anatomic position compressed between the superior mesenteric arteryand the aorta. Posterior NCS (pNCS) is an uncommon anatomic variant in which the LRV courses posterior to
the aorta and is compressed between the aorta and the lumbar vertebra. The incidence of retroaortic LRV is rare (<2%), and the subsequent development of NCS is exceedingly rare with fewer than 30 documented cases in the literature. Written informed consent was obtained from the patient for publication of this case report and accompanying images.
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