Renal nutcracker syndrome is the venous entrapment caused by compression of the left renal vein between the aorta and superior mesen-teric artery (SMA). Stewart BH, Reiman G. Left renal venous hypertension “nutcracker” syndrome managed by direct renocaval reimplantation. 8. autotransplantation of the right kidney would offer the best chance of surgical correction of symptoms. J Urol. 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. Left renal vein transposition for nutcracker syndrome. Nutcracker Syndrome Treatment Nutcracker syndrome treatments can vary based on your age, symptoms, and the severity of your condition. It is an uncommon, although possibly underdiagnosed, condition that may lead to serious complications if left untreated. Magnetic resonance angiography (MRA) followed. 1. 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. 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. Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature 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. 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. 1996, 78:25-28. FIGURE 1. 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 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. 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). 1 Chait et al. J Urol. Surgical approaches reported include venolysis and anterior nephropexy, renal vein bypass or interposition grafting, renocaval reimplantation, and autotransplantation. (A) Axial CT of the abdomen with contrast and (B) coronal reconstruction demonstrating the inverted nutcracker syndrome. Parnham AP, Low A, Finch P, Perlman D, Thomas MA: Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome. 1 Chait et al. Nutcracker syndrome is a venous compression syndrome involving the left renal vein. Chin JL, Kloth D, Pautler SE, Mulligan M: Renal autotransplantation for the loin pain-hematuria syndrome: long-term followup of 26 cases. 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. LRV entrapment divided into 2 types: anterior and posterior. A diagnosis of varicocele rupture secondary to nutcracker phenomenon was made. described the abdominal aorta and the SMA as the two arms of a ‘nutcracker’ that can potentially compress the left renal vein. To report our experience with renal autotransplantation in treatment of gross hema-turia caused by nutcracker Syndrome (NCS). Surgical options for the treatment of nutcracker syndrome include left renal vein transposi-tion, gonadal vein transposition, renocaval bypass, and renal autotransplantation. 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). Treatment of nutcracker syndrome is controversial, with a wide array of therapeutic options. Introduction. One month later, he underwent retroperitoneal laparoscopic donor nephrectomy and subsequent renal autotransplantation into the left iliac fossa. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. 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. 6. Chuang CK, Chu SH, Lai PC. 1. 1997;157:1833-1834. It has also been advocated for ureteral avulsion, urothelial malignancy, renal calculus disease, renal tumor, renal trauma, retroperitoneal fibrosis, and nutcracker syndrome . 1982;20:365-369. Br J Urol. Xu D(1), Liu Y, Gao Y, Zhang L, Wang J, Che J, Zhu Y. Despite modern imaging modalities, the diagnosis of nutcracker syndrome is difficult. The nutcracker syndrome managed by autotransplantation. Objective To study the pathophysiology of the nutcracker syndrome and to describe a new method of treatment.. 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. 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 for Nutcracker Kidney after Prior Right Nephrectomy. 1. Subjects and methods Computerized tomography (CT) was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in three patients with the nutcracker syndrome and in a control group of 12 healthy kidney donors. Manju Kalra Renal ultrasound revealed a ‘swollen’ left kidney. Abstract. Per riportare la nostra esperienza con autotrapianto renale in trattamento di ematuria lordo causata da schiaccianoci Syndrome (NCS). 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. described the abdominal aorta and the SMA as the two arms of a ‘nutcracker’ that can potentially compress the left renal vein. Several treatment options have been described to relieve associated symptoms. 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. It is a rare and commonly overlooked condition. Nutcracker syndrome is defined as left renal vein compression with concomitant clinical symptoms that include flank pain and hematuria. Urology. 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. Renal vein thrombosis is a fairly uncommon site for vascular occlusion when isolated to this location. ... Renal autotransplantation: transfer of a kidney from its original location into the body to another location to prevent [en.wikipedia.org] Nutcracker syndrome is an easily missed cause of hematuria in children. The role of renal autotransplantation in treatment of nutcracker syndrome. Intended for healthcare professionals 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. 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. Scrotal hematoma and marked dilation of left renal vein and left gonadal vein were revealed by computed tomography. 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. Most reports consist of small case series, and long-term results are limited. Neste MG, Narasimhan DL, Belcher KK. The nutcracker syndrome managed by autotransplantation. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. Nutcracker syndrome is one of the many unfortunate consequences of our bipedal lifestyle. 1998, 150:1232-1235. Introduction. Am Surg. Neppala P, Chau HS, Sood D, Berumen J, Mekeel KL. Skip to main content. 2020 Feb 1;86(2):e88-e89. 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. 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 ]. 7. Renal autotransplantation has been used in the management of renal vessel trauma, thrombosis, stenosis, and aneurysms. Journal of Vascular Surgery, 2009. 3-7 a = Right renal vein, b = right-sided aorta, c = superior mesenteric artery, d = left-sided vena cava. 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.

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