https://doi.org/10.4081/vl.2024.12259

Surgical treatment of nutcracker syndrome

Vol. 13 (2024): Early Access
Submitted: 5 January 2024
Accepted: 9 May 2024
Published: 13 May 2024
Nutcracker Syndrome, Left Renal Vein, hematuria, vascular compression
Abstract Views: 396
PDF: 3
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Authors

Nunzio Montelione
n.montelione@policlinicocampus.it
https://orcid.org/0000-0003-0983-7045
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Alessandra Scotto di Uccio
General Surgery and Organ Transplantation Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, School of General Surgery, Sapienza University of Rome, Italy.
Vincenzo Catanese
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Francesco Alberto Codispoti
https://orcid.org/0000-0002-7775-1449
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Alessandro Ciolli
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Vascular Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Julia Paolini
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Vascular Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Alessandra Panichelli
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Research Unit of General Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Francesco Spinelli
https://orcid.org/0000-0001-6527-1993
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Francesco Stilo
https://orcid.org/0000-0001-6527-1993
Research Unit of Vascular Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.

The objective of this paper is to report early and mid-term outcomes of the surgical treatment Nutcracker Syndrome (NCS) in a single-center prospective study. Between January 2019 and September 2023, five patients with symptomatic NCS were treated at our center using left renal vein caudal transposition on the inferior vena cava, conducted through a midline incision of approximately 12 cm and a transperitoneal technique. Patient characteristics, presentation, length of hospital stay, and complications were analyzed. All diagnoses were established after clinical evaluation, ultrasound scanning, and radiological investigations, which confirmed left renal vein compression between the aorta and the Superior Mesenteric Artery (SMA). The average operating time was 159 minutes, with an average blood loss of 205 mL. There was no need for blood transfusions. Intensive care stay was not required and there were no early complications. The mean length of stay was 3.5 days. At a mean follow-up of 18.8 months, one patient reported persistent hematuria, and therefore underwent a secondary procedure, which incorporated patch venoplasty using the great saphenous vein. In our experience, left renal vein transposition appears to be a safe and effective procedure for the surgical management of severe NCS.

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How to Cite

Montelione, N., Scotto di Uccio , A., Catanese, V., Codispoti, F. A., Ciolli, A., Paolini, J., Panichelli, A., Spinelli, F., & Stilo, F. (2024). Surgical treatment of nutcracker syndrome. Veins and Lymphatics, 13. https://doi.org/10.4081/vl.2024.12259
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