Nutcracker Syndrone

Causes Of Nutcracker Syndrome

• The left kidney vein has to cross over the left sided Aorta to get to the right sided Vena Cava.
• When the kidney vein goes in front of the aorta, it may be pinched by the intestinal artery (SMA- superior Mesenteric Artery) Anterior Nutcracker Syndrome.
• On rare occasions the kidney vein will go behind the Aorta.  The kidney vein will be squeezed  against the backbone Posterior Nutcracker Syndrome.

The blood leaving the kidney finds its way out by taking side branches. These include the ovary vein, the adrenal gland vein, the diaphragm vein, or veins along the backbone itself.

Pelvic Congestion Syndrome may result when the ovary vein is involved, overloaded and filling the pelvic veins.

The symptoms include:

• Left flank pain. Flank is the area where the ribs join the backbone.
• Hematuria–Blood in the urine
  • Can be either visible.
  • Or found on microscopic urinalysis.
  • Over time can lead to anemia.
• Proteinuria—protein in the urine.

• Symptoms are due to blockage of the left kidney vein between the SMA and Aorta.

• Abdominal venous ultrasound requires additional training and usually only done by Vein specialists.
• CT scan or MRI with special programming for the veins.
• Venogram with injections of dye into the kidney vein is best.

• Open Surgical Bypass of the blocked Renal vein.
• Removal of the kidney (Nephrectomy) in worse case scenarios.
• Stenting of the kidney vein has been tried with some success and some complications. It is not yet the gold standard.