Nutcracker syndrome due to left-sided inferior vena cava compression and treated with superior mesenteric artery transposition

J Vasc Surg. 2012 Sep;56(3):816-8. doi: 10.1016/j.jvs.2012.03.021. Epub 2012 Jul 21.

Abstract

Left renal vein hypertension secondary to left renal vein compression has been described as a cause of persistent hematuria in nutcracker syndrome. Malformation of the inferior vena cava (IVC), although rare and frequently asymptomatic, may also result in left renal vein hypertension, with resultant hematuria when it is severely compressed. We report a 20-year-old man with persistent hematuria due to compression of left-sided IVC. The patient was successfully treated by means of superior mesenteric artery (SMA) transposition and division of the fibrous bundle at the origin of the SMA. His postoperative course was uneventful. Compression of the left IVC is a unique form of nutcracker syndrome. SMA transposition, together with division of a fibrous bundle at the origin of the SMA if present, is a safe and effective surgical procedure for this special entity.

Publication types

  • Case Reports

MeSH terms

  • Decompression, Surgical / methods*
  • Hematuria / etiology
  • Hematuria / surgery
  • Humans
  • Hypertension, Renovascular / etiology
  • Hypertension, Renovascular / surgery
  • Male
  • Mesenteric Artery, Superior / diagnostic imaging
  • Mesenteric Artery, Superior / surgery*
  • Phlebography / methods
  • Renal Nutcracker Syndrome / diagnostic imaging
  • Renal Nutcracker Syndrome / etiology
  • Renal Nutcracker Syndrome / surgery*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Malformations / complications
  • Vascular Malformations / diagnostic imaging
  • Vascular Malformations / surgery*
  • Vascular Surgical Procedures*
  • Vena Cava, Inferior / abnormalities*
  • Vena Cava, Inferior / diagnostic imaging
  • Young Adult