It is a commonly missed and potentiallytreatable cause of chronic abdominopelvic pain. The nutcracker syndrome in a venous or even broader scope, vascular compression syndromes is based upon decreased space between the superior mesenteric artery and the aorta in the area of the left renal vein. Nutcracker syndrome is a variation of nutcracker phenomenon or renal vein entrapment syndrome, in which the arteries near the kidney compress the left renal kidney vein. Chronic pelvic pain is defined as noncyclic pain lasting greater than six months. I am on hrt with hormone pellets containing testosterone and estradiol. The nutcracker syndrome ncs is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. In most cases, compression of the left renal vein is between the abdominal aorta the main artery in the abdomen and the superior mesenteric artery, which brings blood to the pancreas and intestines.
May 03, 2017 the term syndrome refers to a group of signs and symptoms primarily occurring together, characteristic of a specific condition. This article reports the treatment of two cases of nutcracker syndrome using laparoscopic inferior mesentericgonadal vein bypass, knowing that this treatment option would avoid renal reperfusion injury and lrv hypertension. The condition may cause chronic pain, such as a constant dull ache, which can be worsened by standing or sex. Questions to ask your doctor before treating pelvic.
Pelvic venous congestion syndrome is also known as ovarian vein reflux. The posterior nutcracker syndrome is caused when there is compression of the left renal vein between the abdominal aorta and the bones of the spine. A multidisciplinary team approach is needed to treat this often complex. Phlebolymphology is an international scientific journal entirely devoted to venous and lymphatic diseases. Pelvic congestion syndrome pcs, also known as pelvic vein incompetence or pelvic vein reflux, is a chronic medical condition in women caused by varicose veins in the lower abdomen.
Surgical options, abstract nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Some people may not have symptoms, while others develop severe and. This is usually secondary to varicoses of the ovarian vein or ovarian vein thrombosis and occurs at the point where the ovarian vein. Thefactthatpcsonlyaffects premenopausal women suggests a strong correlation between pcs and ovarian activity. Pelvic congestion syndrome pcs is characterized by chronic pelvic discomfort exacerbated by prolonged standing and coitus in women who have periovarian varicosities on imaging. My nephrologist believes i may have nutcracker syndrome. However, it is estimated to be relatively more common in females and usually presents in the 3rd or 4th decade of life. Many doctors who start seeing patients for pcs will diagnose compression syndromes such as maythurner syndrome and nutcracker syndrome because they see narrowing of veins above areas that reflux. Nutcracker syndrome refers to the compression of the left renal vein between the aorta and the superior mesenteric artery, which results in elevated left renal vein pressure and possible collateral vein development. It occurs when arteries, most often the abdomens aorta and superior mesenteric artery, squeeze the. This is usually secondary to varicoses of the ovarian vein or ovarian vein thrombosis and occurs at the point where the ovarian vein crosses the ureter.
The pelvic venous syndromes, which include pelvic congestion syndrome and vulvar varicosities, are poorly understood disorders of the pelvic venous circulations. This leads to lrv varices, left gonadal vein varices and therefore, the pelvic congestion syndrome. Duplex ultrasound investigation in pelvic congestion. Pelvic congestion syndrome radiology reference article. Nutcracker syndrome is caused by stenosis of the left renal vein lrv as it passes anteriorly to the aorta through the fork formed by both abdominal aorta aa and superior mesenteric artery sma.
The nutcracker syndrome results most commonly from the compression of the left renal vein between the abdominal aorta and superior mesenteric artery, although other variants exist. The underlying anatomic anomaly, first described by gant in 1937, can lead to left renal venous. Nutcracker syndrome is a complex of clinical symptoms due to compression of the left renal vein between abdominal aorta and superior mesenteric artery. The blood flow is diverted into other veins, most commonly the ovarian vein. Each of these treatment modalities is associated with significant immediate and longterm risks. Nutcracker syndrome can be treated, and treatments depend on your age, anatomy, and symptoms. This narrowing of the left renal vein can lead to increase venous. Pelvic congestion syndrome, also known as pelvic vein incompetence, is a long term condition in women believed to be due to enlarged veins in the lower abdomen. Pelvic congestion syndrome pelvic pain in women often. Nutcracker syndrome ncs refers to the clinical manifestations of ncp.
Patients with left renal vein compression nutcracker syndrome can be referred for ovarian vein transposition. Veins carry blood from all areas of your body back to the heart. The nutcracker syndrome is a rare but possibly underestimated condition and is seldom suspected in a pregnant patient. Early resolution of pelvic venous collaterals after endovascular. A therapeutic option in nutcracker syndrome and ovarian. Nutcracker syndrome wikimili, the free encyclopedia. Pelvic pain pelvic congestion syndrome ovarian vein and pelvic varices what is it. New procedure offers speedier recovery for patients with nutcracker syndrome. In about half the cases, pelvic venostasis develops due to distension of the left ovarian or. Nutcracker phenomenon and nutcracker syndrome mayo clinic. Another clinical study has shown that nutcracker syndrome is a frequent finding in varicoceleaffected patients and possibly, nutcracker syndrome should be routinely excluded as a possible cause of varicocele and pelvic congestion. The nutcracker syndrome ncs is the clinical equivalent of nutcracker phenomenon characterized by a complex of. A diagnosis of left renal vein entrapment nutcracker syndrome, ncs was supported by. 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.
Renal vein entrapment the nutcracker syndrome brandon t. The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. A diagnosis of nutcracker syndrome was made and a left renal. Gonadal vein transposition for the treatment of nutcracker syndrome. To assess diagnosis of the nutcracker renal vein entrapment syndrome with doppler ultrasonography us. The left ovarian vein drains most often into the left renal vein. The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa appear to be a nutcracker crushing a nut. Unusual presentation of nutcracker syndrome in patient with prior gonadal vein embolization for pelvic congestion syndrome.
More rarely, an ovarian varicocele may develop as a result of backpressure from the inferior vena cava or left renal vein. In nutcracker syndrome, the renal vein coming from your left kidney becomes compressed and blood cant flow through it normally. It results when the left renal vein is compressed between the aorta and the superior mesenteric artery. In addition the patient had dilated gonadal and pelvic collaterals. This causes chronic or colicky abdominal pain, back pain andor pelvic pain.
They had a significant difference in both the hilar and amp peak flow velocity p. Mar 22, 2018 the term nutcracker phenomenon ncp refers to compression of the left renal vein lrv between the aorta and the superior mesenteric artery sma. The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and. She was diagnosed in april 2009 after over a year and a half of trying to figure out what was wrong. Left renal vein transposition for nutcracker syndrome. Last year i had surgery for nutcracker syndrome, and later had my left ovarian vein coiled due to symptoms of pelvic congestion. Ovarian vein thrombophlebitis, a condition which typically presents in the first few days postpartum with iliac fossa pain, fevers, and often a pelvic or abdominal mass should be excluded if such features are present. Treatment of pelvic venous congestion and the nutcracker syndrome can be. It is a cause of chronic pain in approximately of chronic pelvic pain is pain in the lower which has been present for more than 6 months. Patients with varicocele and nutcracker syndrome did not have a significant difference in either the hilar or amp diameter compared with patients with varicocele without nutcracker syndrome. Laboratory tests for those cases frequently show signs of microhematuria, usually associated with the nutcracker syndrome, an anatomical variation in which the superior mesenteric artery sma and the aorta perform a clamping of the left renal vein, with consequent reflux in the proximal portion of that vein and of the left ovarian vein. The nutcracker syndrome has two types of occurrence, namely anterior and posterior renal nutcracker syndromes.
Youve been diagnosed with pelvic congestion syndrome. The exact prevalence of nutcracker syndrome is unknown, likely because of the variable presenting features. This allows blood to build up or pool, causing pressure and bulging veins resulting in varicose veins in the pelvis. It is a cause of chronic pelvic pain in approximately 40% of women. This damages the ovarian vein valves and makes varicose veins in the pelvis. Left renal vein transposition is an efficient surgical treatment for nutcracker syndrome. The nutcracker syndrome ncs is the clinical equivalent of. Jan 16, 2017 in hindsight, technically, i actually have nutcracker phenomenon too as the left renal vein is only of reduced calibre but i have a massively enlarged let ovarian vein which different doctors have referred to as both nutcracker phenomenon and nutcracker syndrome. Nutcracker syndrome ncs describes left renal vein compression. Furthermore, the venous return from the left gonadal vein returning to the left renal vein is blocked, thus causing testicular pain. Ovs should be distinguished from pelvic congestion syndrome pcs. An example of this is the nutcracker syndrome, in which the left renal vein is compressed between the aorta and the superior mesenteric artery. However, obstruction of the gonadal outflow may produce similar symptoms. Laparoscopic inferior mesentericgonadal vein bypass for.
Nutcracker syndrome accompanying pelvic congestion syndrome. Doppler us findings in 16 patients with the nutcracker syndrome and in 18 healthy control subjects were compared. Meissner the nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. The left kidney vein has to cross over the left sided aorta to get to the right sided vena cava. Mesoaortic compression of the left renal vein nutcracker syndrome produces both. Nutcracker syndrome, maythurner syndrome and pelvic congestion syndrome explained by prof mark whiteley of the whiteley clinic. In some cases however pelvic pain remains following left renal vein transposition. We finally went to mayo clinic and she was diagnosed there.
Nutcracker syndrome is a rare vein compression disorder. It is estimated that a third of all women will experience chronic pelvic pain during their lifetime. The diagnosis of pelvic congestion syndrome is established by the demonstration of multiple dilated, tortuous parauterine veins with a width 4 mm or an ovarian vein diameter greater than 56 mm 4. When symptomatic, such compressions can result in a variety of uncommon syndromes in the abdomen and pelvis, including median arcuate ligament syndrome mals, maythurner syndrome, nutcracker syndrome, superior mesenteric artery sma syndrome, upj obstruction, ovarian vein syndrome ovs, and other forms of ureteral compression. Nov 09, 2016 nutcracker syndrome treatment options. Nutcracker syndrome ncs is a rare vascular anomaly involving left renal vein outflow entrapment most commonly secondary to compression between the aorta and the superior mesenteric artery.
Nutcracker syndrome ncs is the set of clinical manifestations of venostasis induced by left renal vein lrv compression nutcracker phenomenon between the superior mesenteric artery sma and aorta anterior ncs or between the aorta and spine when the lrv is retroaortic posterior ncs syndrome. Vulvovaginal varicosities and pelvic congestion syndrome. Dilated left gonadal vein and pelvic varices indicate left renal vein lrv ouflow obstruction by the superior mesenteric artery sma i ordered a renal duplex and a ct venogram for procedural planning. Nutcracker syndrome european journal of vascular and. This syndrome results most commonly from the compression of the left renal vein between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. Renal nutcracker syndrome genetic and rare diseases.
Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric artery sma and aorta, although other variations can exist 1. This condition results in chronic pelvic pain, estimated to affect onethird of women in the united states pelvic congestion syndrome is caused by dilatation of the ovarian andor. In women, the hypertension in the left gonadal vein can also cause increased pain during menses. Imaging findings and clinical features of abdominal vascular. Nutcracker phenomenon refers to compression of the left renal vein, most. Treatment options for pelvic congestion syndrome servier. Nutcracker syndrome accompanying pelvic congestion. This vascular compression may lead to hypertension of the left renal vein and a possible emergence of collateral veins4. I just recently had a major surgery for something called nutcracker syndrome. Pelvic congestion syndrome occurs mostly because of ovarian vein.
Jun 12, 2016 the presence of hematuria, proteinuria, and pain albeit atypically right sided made it nutcracker syndrome. Nutcracker syndrome is a rare entity caused by extrinsic compression on the left renal vein lrv crossing between the superior mesenteric artery and the aorta. Now, i am experiencing identical paindiscomfort, but my new gynecologist says i am too old to have pelvic congestion syndrome. If this treatment option is not available, then the decision to embolize the left ovarian vein should be made based on the degree of left renal venous collateralization.
The nutcracker syndrome ncs is compression of the left renal vein. The nutcracker syndrome is an unusual problem where the left renal vein is narrowed as it passes between an angle formed between the abdominal aorta and the superior mesenteric artery. Some subtypes of pelvic congestion syndrome include ovarian vein reflux, nutcracker syndrome, and maythurner syndrome. Clinically, nutcracker syndrome is characterized by intermittent hematuria with or without left flank or abdominal pain. Multidetector ct of vascular compression syndromes in the. She had surgery, which is left renal vein transposition, where. Nutcracker syndrome pelvic congestion syndrome linked. Normally, the angle between the sma and aa is approximately 450. International journal of science and research ijsr is published as a monthly journal with 12 issues per year. Jun 22, 2017 renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. My daughter has nutcracker syndrome testicular disorders. This kidney vein blockage can also cause left flank pain or blood or protein in the urine nutcracker syndrome. This can lead to renal venous hypertension, resulting in rupture of thinwalled veins into.
They logically think that the narrow area is stopping blood from getting through, dilating the vein below and causing it to reflux. Notably, it is a referred, highly indexed, online international journal with high impact factor. Coexistant superior mesenteric artery syndrome and. In medicine, ovarian vein syndrome is a rare possibly not uncommon, certainly underdiagnosed condition in which a dilated ovarian vein compresses the ureter the tube that brings the urine from the kidney to the bladder. Venography revealed compression of the left renal vein, extensive pelvic varices, and significant engorgement of her left ovarian vein. Ovarian vein syndrome is a relatively rare condition where a dilated ovarian vein ovarian venous varix causes notching, dilatation, or obstruction of the ureter.
However, in some women, the veins in the lower abdomen have weakened, making their veins inefficient at moving the blood back up to their heart. Although often asymptomatic, it may result in varicocele, ovarian vein syndrome, haematuria, flank or abdominal pain, lrv hypertension, and pelviureteral varices. Although most cases are asymptomatic, this syndrome may result to varicocele, ovarian vein syndrome, hematuria, flank or abdominal pain, lrv hypertension, and pelviuteral varices 3. Jan 01, 2000 the clinical syndrome caused by impingement of the left renal vein lrv between the superior mesenteric artery sma and abdominal aorta has been termed nutcracker syndrome.
Search for anatomical and hemodynamic criteria of the nutcracker syndrome ncs. Nutcracker syndrome ncs is a rare pathology, caused by compression of the left renal vein lrv between the abdominal aorta aa and the superior mesenteric artery sma, due to reduction of the angle between aa and sma. Pelvic congestion syndrome ultrasound exam, risk factors. Is it possible to have pelvic congestion at age 66. Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. Pelvic congestion syndrome pcs is a condition that causes chronic pelvic pain due to problems with your veins in your lower abdomen. In some severe cases of nutcracker syndrome, your doctor may suggest vascular surgery to relieve the pressure on your left renal vein. In some cases, nutcracker syndrome may not need treatment, especially for patients who are. The clinical syndrome caused by impingement of the left renal vein lrv between the superior mesenteric artery sma and abdominal aorta has been termed nutcracker syndrome. Left ovarian to left external iliac vein transposition for. A therapeutic option in nutcracker syndrome and ovarian vein.
This report provides the details of a simpler technique for the treatment of nutcracker syndrome by transposing the distal left ovarian to the left external iliac vein. Ovarian vein embolization for the treatment of pelvic congestion syndrome. May 15, 2014 nutcracker syndrome ncs is a rare pathology, caused by compression of the left renal vein lrv between the abdominal aorta aa and the superior mesenteric artery sma, due to reduction of the angle between aa and sma. Instead, blood can flow backwards into other veins and cause them. I had a ct scan with contrast dye and my kidneys looked great. Surgical treatment for nutcracker syndrome can include moving the left renal vein and reattaching it, or a left renal vein bypass. It is due to the compression of the distal segment of the left renal vein lrv between the superior mesenteric artery sma and the aorta also called left renal vein entrapment. Since the left gonadal vein drains via the left renal vein, it can also result in left testicular pain in men or left lower quadrant pain in women, especially during. Diagnosis and surgical treatment of nutcracker syndrome. Unusual presentation of nutcracker syndrome in patient with prior. Nutcracker phenomenon ncp describes the compression of the left renal vein between the aorta and the superior mesenteric artery. Nutcracker syndrome symptoms, treatment, causes, surgery. It is sometimes described as part of the gonadal vein pain syndrome, which is.