ANATOMICAL VARIATIONS CAUSING LEFT RENAL VEIN COMPRESSION IN NUTCRACKER SYNDROME: A CASE REPORT
Main Article Content
Abstract
Background: Nutcracker syndrome refers to compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Although uncommon, it is an important diagnosis because of its associated complications, including the risk of chronic kidney disease secondary to prolonged renal venous hypertension and the potential development of renal vein thrombosis.
Case presentation: A 52 year old female with no significant past medical history presented with dull left flank pain and lower abdominal pain associated with severe dysmenorrhea. Computed tomography demonstrated compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, along with dilatation of the ovarian vein. With a diagnosis of Nutcracker syndrome, the patient underwent ovarian vein embolization. Following the intervention, the patient experienced significant symptom relief and was discharged after 2 days. Follow-up examinations at 1 month and 3 months showed favorable outcomes.
Conclusion: Ovarian vein embolization may represent a minimally invasive and effective therapeutic option for patients with Nutcracker syndrome presenting predominantly with pelvic congestion syndrome. However, treatment strategies should be individualized for each specific case.
Article Details
Keywords
Nutcracker syndrome, left renal vein, pelvic congestion syndrome, ovarian vein embolization.
References
[2] Ananthan K, Onida S, Davies A.H. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg, 2017, 53 (6): 886-94. doi: 10.1016/j.ejvs.2017.02.015.
[3] Penfold D, Leslie S.W, Lotfollahzadeh S. Nutcracker syndrome and left renal vein entrapment. In: StatPearls. StatPearls Publishing, 2024 [cited 2026 May 24]. https://www.ncbi.nlm.nih.gov/books/NBK559189/ PubMed PMID: 32644615.
[4] Orczyk K, Wysiadecki G, Majos A, Stefańczyk L, Topol M, Polguj M. What each clinical anatomist has to know about left renal vein entrapment syndrome (Nutcracker syndrome): a review of the most important findings. BioMed Res Int, 2017, 2017: 1746570. doi: 10.1155/2017/1746570.
[5] Kalantar D.S, Park S.J, Shin J.I. Nutcracker syndrome in children: review of symptom, diagnosis, and treatment. Child Kidney Dis, 2023, 27 (2): 89-96. doi: 10.3339/ckd.23.018
[6] Mačionienė E, Kerpauskienė A, Žakauskienė U, Vitkauskaitė M, Girčius R, Miglinas M. Nutcracker syndrome in 2026: a nephrologist-oriented diagnosis and management. Clin Kidney J, 2026, 19 (5): sfag124. doi: 10.1093/ckj/sfag124
[7] Mosavari H, Sarafi M, Hosseininasab A, Narimani N, Khaleghian M, Saberi A. Renal nutcracker syndrome presenting with varicocele: a case series. Int J Surg Case Rep, 2024, 124 (C): 110393. doi: 10.1016/j.ijscr.2024.110393
[8] Ribeiro F.S, Puech-Leão P, Zerati A.E, Nahas W.C, David-Neto E, De Luccia N. Prevalence of left renal vein compression (nutcracker phenomenon) signs on computed tomography angiography of healthy individuals. J Vasc Surg Venous Lymphat Disord, 2020, 8 (6): 1058-65. doi: 10.1016/j.jvsv.2020.04.005.
[9] Perkov D, Vrkić Kirhmajer M, Novosel L, Popić Ramač J. Transcatheter ovarian vein embolisation without renal vein stenting for pelvic venous congestion and nutcracker anatomy. VASA Z Gefasskrankheiten, 2016, 45 (4): 337-41. doi: 10.1024/0301-1526/a000547.
[10] Maleux G, Stockx L, Wilms G, Marchal G. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol JVIR, 2000, 11 (7): 859-64. doi: 10.1016/s1051-0443(07)61801-6.
[11] d’Archambeau O, Maes M, De Schepper A.M. The pelvic congestion syndrome: role of the “Nutcracker phenomenon” and results of endovascular treatment. JBR-BTR Organe Soc R Belge Radiol SRBR Orgaan Van K Belg Ver Voor Radiol, 2004, 87 (1): 1-8.