Affiliations: Department of Radiology, the First Affiliated Hospital
of Sun Yat-Sen University, Guangzhou, Guangdong, China | Department of Urology, the First Affiliated Hospital
of Sun Yat-Sen University, Guangzhou, Guangdong, China | Wake Forest Institute for Regenerative Medicine, Wake
Forest University School of Medicine, Winston-Salem, NC, USA
Note: [] Corresponding authors: Yuanyuan Zhang, Wake Forest Institute for
Regenerative Medicine, Wake Forest University School of Medicine,
Winston-Salem, NC, USA. E-mail: yzhang@wakehealth.edu. Jianping Chu, Department
of Radiology, the First Affiliated Hospital of Sun Yat-sen University,
Guangzhou, Guangdong 510080, China. E-mail: jxgdhp@163.com
Abstract: The nutcracker syndrome is a rare clinic condition associated with
severe hematuria and left flank pain due to the entrapment of the left renal
vein between the superior mesenteric artery and the aorta. Its diagnostic
criteria are not well defined, often causing delayed or misdiagnosis. Although
surgical repair has been the standard of care, more recently endovascular
stenting of the renal vein has been proposed. We presented six patients (aged 7
to 31 years old; median age, 16.5 years old) with nutcracker syndrome who were
endovascularly managed from June 2002 to July 2011. All patients underwent
laboratory test and computed tomography (CT) or ultrasound examination before
and after endovascular procedures. Self-expandable stents were successfully
placed in all cases. The diameter of the left renal vein at aorto-superior
mesenteric artery portion significantly increased from 1.88 ± 0.95 mm
pre-procedure to 5.24 ± 0.61 mm post-procedure (p< 0.01). Left renal
vein pressure significantly decreased from 11.00 ± 4.34 mmHg
pre-procedure to 6.00 ± 2.55 mmHg post-procedure (p< 0.01). Severe
gross hematuria completely subsided within 2 months to 6 months and left flank
pain completely subsided within 7 days to 1 month after treatment. Endovascular
therapy provides an alternative therapy with satisfactory long-term clinical
and imaging results for symptomatic patients with nutcracker syndrome.
