Nutcracker Syndrome and stent angioplasty treatment

Abstract

Objective: To present a favorable clinical outcome in a patient with Nutcracker Syndrome, using a stent technique as a promising form of treatment. Case details: This is a 47-year-old female patient diagnosed with Nutcracker Syndrome, who has been experiencing chronic pelvic pain since her adolescence, left flank pain, and episodes of hematuria. She underwent a transvaginal ultrasound, which revealed pelvic varices, and a total abdominal ultrasound, which showed dilatation of the gonadal veins and significant stenosis of the left renal vein. The patient was subjected to angioplasty with an XL 16x40 stent of the renal vein and the embolization of the associated pelvic varices. The patient progressed without any complications and was discharged with a prescription for acetylsalicylic acid. Final considerations: Nutcracker Syndrome clinically manifests as compression and subsequent stenosis of the left renal vein by the superior mesenteric artery and/or the aorta, with various treatments ranging from conservative approaches and open surgery to endovascular methods. With the development of new technologies, endovascular treatment has become a less invasive option compared to open surgeries due to its lower invasive and iatrogenic nature, thereby offering a reduced risk of morbidity and complications for the patient.