Nutcracker Syndrome

Compression of the left renal vein
Nutcracker syndrome (nutcracker syndrome, nutcracker, left renal vein compression) is, schematically, a compression of the left renal vein by the aorta and the superior mesenteric artery.

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Venous return is hindered by this compression and the dilation of the poorly draining veins causes the symptoms. There may be repercussions on the kidney.
Diagram of compression of the left renal vein and its consequences

This syndrome occurs preferentially in women and can manifest as the equivalent of pelvic congestion syndrome with pelvic pain or pain localized on the left flank, hematuria (blood in the urine) and proteinuria (presence of protein in the urine).

Angio-CT scan is a good examination to confirm the diagnosis. Before proposing treatment, several consultations are necessary to assess the discomfort, the impact on daily life, and any possible renal manifestations.
Sometimes gaining weight in very thin individuals can improve or eliminate clinical signs by reducing compression of the renal vein.

Historical treatments are surgical (transposition and release of the renal vein, transposition of the superior mesenteric artery). Reimplantation of the left ovarian vein into the vena cava has been described, but it appears that the placement of stents in the renal vein gives excellent results in several publications without the risks of surgery.

When possible, we favour endovascular treatments for left renal vein compression syndromes. Associated pelvic varicose veins can be treated at the same time by embolization.
During several pre-operative consultations, the surgeon will determine the treatment indication and decide with the patient on the best therapeutic strategy.
Dr. Guilhem Seban, a vascular surgeon in Annemasse, treats left renal vein compression syndromes (Nutcracker Syndrome).

Learn more:

https://www.ejves.com/article/S1078-5884(17)30126-0/fulltext
Nutcracker syndrome: diagnosis and therapy.Kolber M et al.Cardiovascular Diagnosis and Therapy. 2021
Nutcracker syndrome: challenges in diagnosis and surgical treatment. Dieleman F et al. Ann Vasc Surg. April 4, 2023