Gonadal Vein Transposition in Nutcracker Syndrome.

BACKGROUND: Nutcracker syndrome, caused by mesoaortic compression of the left renal vein leading to symptoms related to venous hypertension, is an uncommon entity that may require operative intervention. Traditional open transposition of the left renal vein to the vena cava has been shown to have a reintervention rate of up to 30%, while also having additional morbidity associated with laparotomy. More recently, endovascular stenting has been described in several small series but have reported stent fracture, thrombosis, and migration. METHODS: We report the case of a 26-year-old woman with 4 months of intermittent flank pain and hematuria, diagnosed with nutcracker syndrome by both duplex ultrasound and axial based imaging. RESULTS: The patient underwent catheter venography confirming left renal vein compression, which also demonstrated a dilated gonadal vein measuring 11 mm leading to significant pelvic varices. Through a left lower quadrant retroperitoneal exposure, the gonadal vein was transposed to the left common iliac vein with completion venography demonstrating relief of renal venous congestion. The patient was discharged uneventfully with immediate resolution of symptoms and remains symptom-free at 6-month follow-up. CONCLUSIONS: Gonadal vein transposition is an effective alternative surgical treatment for nutcracker syndrome