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Nutcracker Syndrome

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Venous Disorders

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Abstract

Left renal vein (LRV) compression between the superior mesenteric artery (SMA) and abdominal aorta is referred to as the nutcracker phenomenon (NCP) or LRV entrapment and was first described by anatomist Grant in 1937 [1]. Abdominal aorta and superior mesenteric artery (SMA) act as two arms of a ‘nutcracker’ that can potentially compress the left renal vein [2]. The term nutcracker syndrome (NCS) is the clinical presentation of this phenomenon which is assigned to those patients who present with signs or symptoms of left renal venous congestion and have the anatomical LRV compression [3]. De Schepper, a Belgian physician named this phenomenon as ‘nutcracker syndrome’ [4]. Anatomically classical anterior nutcracker syndrome, in which there is compression of distal LRV between aorta and proximal SMA, is analogous to superior mesenteric artery syndrome (Wilkie’s syndrome) wherein the third part of duodenum gets compressed anteriorly by SMA and posteriorly by aorta [5–10]. The retroaortic or circumaortic renal vein may get compressed between the aorta and the vertebral body causing symptom which is called posterior nutcracker syndrome [11]. NCP on the right side, due to compression of large veins by the gravid uterus, has been also reported [12].

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Author information

Authors and Affiliations

  1. Postgraduate Institute of Medical Education and Research, Trivandrum, India

    Ajay Savlania

  2. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

    Shivanesan Pitchai

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  1. Ajay Savlania
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  2. Shivanesan Pitchai
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Editors and Affiliations

  1. Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Ajay K. Khanna

  2. Vascular and Endovascular Surgery, Fortis Hospital, Mohali, India

    Ravul Jindal

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Savlania, A., Pitchai, S. (2018). Nutcracker Syndrome. In: Khanna, A., Jindal, R. (eds) Venous Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-13-1108-6_18

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  • DOI: https://doi.org/10.1007/978-981-13-1108-6_18

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