Abstract
Nutcracker syndrome is compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, resulting in congestion in the renal vein. Clinically, the syndrome is manifested by phlebohypertension, hematuria, orthostatic proteinuria, systemic arterial hypertension, girdle pain, and, in severe cases, renal dysfunction. Prolonged venous compression can contribute to the development of collateral outflow tracts through the gonadal and pelvic veins, which may be one of the reasons leading to phlebohypertension of the corresponding pool and the development of complications from the pelvic organs. Differential diagnosis can be difficult often using a combination of Doppler ultrasound, multislice computed tomography – aortography with contrast agent, and phlebography. Currently, several approaches have been proposed in the treatment of aorto-mesenteric compression of the LPV: conservative therapy (ACE inhibitors), open surgery, endovascular intervention (LPV stenting), hybrid intervention, including LPV stenting with laparoscopic exofixation. However, at the moment there is no clear algorithm for managing patients with this pathology due to the rare occurrence of the disease, the variability and duration of the course, as well as the age category of patients. In the review, we will discuss general issues: etiology, epidemiology, pathogenesis, and diagnostic aspects.
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About the authors
- Valeriy S. Arakelyan, Dr. Med. Sci., Professor, Head of the Department, Cardiovascular Surgeon; ORCID
- Marta M. Nikogosyan, Cardiovascular Surgeon, Applicant; ORCID
- Nazim R. Gamzaev, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
