Nutcracker Syndrome



Nutcracker syndrome refers to the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta (Fig. 22.1) It is a relatively uncommon entity predominately affecting young men and middle-aged women, often seen in association with a thin body habitus Symptomatic patients may present with left flank pain, hematuria, and associated symptoms of pelvic congestion


Inferior Vena Cava Superior Mesenteric Artery Renal Vein Left Renal Vein Superior Mesenteric Artery Syndrome 
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  1. 1. 
    Menard MT. Nutcracker Syndrome: When Should It Be Treated and How? Perspectives in Vasc Surg and Endovasc Therapy 2009 Jun;21(2):117–24. ® Recent comprehensive review on the subject. CrossRefGoogle Scholar
  2. 2. 
    Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syndrome: it’s role in the pelvic venous disorders. J Vasc Surg. 2001;34:812–819. ® Good overview of the pathophysiology of pelvic venous disease. PubMedCrossRefGoogle Scholar
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    Reed NR, Kalra M, Bower TC, Vrtiska TJ, Ricotta JJ 2nd, Gloviczki P. Left renal vein transposition for nutcracker syndrome. J Vasc Surg. 2009;49:386–393. ® Largest and most contemporary series. PubMedCrossRefGoogle Scholar
  4. 4. 
    Neste MG, Narasimham DL, Belcher KK. Endovascular stent placement as a treatment for renal venous hypertension. J Vasc Interv Radiol. 1996;7:859–861. ® First published description of endovascular treatment for renal vein stenosis. PubMedCrossRefGoogle Scholar
  5. 5. 
    Chiesa R, Anzuini A, Marone EM, et al. Endovascular stenting for the nutcracker phenomenon. J Endovasc Ther. 2001;8:652–655. ® Excellent review of endovascular therapy for nutcracker syndrome. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Vascular and Endovascular Surgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Division of Vascular SurgeryUniversity of Maryland School of MedicineBaltimoreUSA

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