The nutcracker syndrome: Its role in the pelvic venous disorders

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Presentation transcript:

The nutcracker syndrome: Its role in the pelvic venous disorders Anke H. Scultetus, MD, J.Leonel Villavicencio, MD, FACS, David L. Gillespie, MD Journal of Vascular Surgery Volume 34, Issue 5, Pages 812-819 (November 2001) DOI: 10.1067/mva.2001.118802 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 MRI demonstrating compression of the left renal vein between the SMA and the aorta (nutcracker syndrome). Dilatation of the left renal vein and perirenal varicosities is clearly observed. Journal of Vascular Surgery 2001 34, 812-819DOI: (10.1067/mva.2001.118802) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Retrograde catheterization of left renal and gonadal veins. A, The left renal vein shows the point of compression of the SMA and a very large left gonadal vein (normal, 3-4 mm diameter). B, Nutcracker syndrome. Retrograde catheterization of the left renal vein shows mesoaortic compression (vertical arrow ), of the left renal vein and perirenal varicosities (horizontal arrow ). Obstruction of the gonadal outflow is evident. Kinking and curls of the gonadal vein are the radiographic manifestations of obstruction. Patient had left-flank pain and hematuria. Journal of Vascular Surgery 2001 34, 812-819DOI: (10.1067/mva.2001.118802) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 One-week postoperative MRI of ES in a case of nutcracker syndrome. Externally reinforced PTFE stent is clearly visible. Partial thrombosis of the left renal vein was observed. The patient was treated with anticoagulants. Six months later, the renal vein had recanalized and the patient's symptoms had greatly improved. Journal of Vascular Surgery 2001 34, 812-819DOI: (10.1067/mva.2001.118802) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Human cadaver specimens. A, SMA compressing the left renal vein against the aorta. B, Lifting the SMA reveals a flattened left renal vein. This compression produced changes in the renal vein wall similar to those described in the Cockett syndrome. Journal of Vascular Surgery 2001 34, 812-819DOI: (10.1067/mva.2001.118802) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions