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Hybrid intervention for treatment of the nutcracker syndrome

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1 Hybrid intervention for treatment of the nutcracker syndrome
Arjun Jayaraj, MBBS, Peter Gloviczki, MD, Syed Peeran, MD, Linda Canton, RN  Journal of Vascular Surgery Cases  Volume 1, Issue 4, Pages (December 2015) DOI: /j.jvsc Copyright © 2015 The Authors Terms and Conditions

2 Fig 1 Patient 1. A, Preoperative computed tomography (CT) venogram (sagittal view) demonstrates compression of the left renal vein (LRV; arrow) in the aortomesenteric window (AMW) and persistent narrowing of the AMW several centimeters distal to the superior mesenteric artery (SMA) origin with consequent risk of compression of the distally transposed LRV. B, Intravascular ultrasound (IVUS) demonstrates LRV compression (arrow) intraoperatively. C, IVUS demonstrates LRV compression relief (arrow) after lifting of the small bowel (SMA). D, IVUS demonstrates a widely patent LRV stent intraoperatively (arrow). E, Intraoperative picture demonstrates the transposed, patched LRV with intraluminal stent. F, Postoperative CT venogram demonstrates a widely patent LRV stent. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

3 Fig 2 Patient 2. A, Preoperative computed tomography (CT) venogram demonstrates compression of the left renal vein (LRV). B, Intraoperative picture demonstrates the transposed, patched LRV with an intraluminal stent. C, Postoperative CT venogram demonstrates a widely patent LRV stent. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

4 Fig 3 Illustration of the hybrid repair (reproduced with permission from the Mayo Foundation). A, Left renal vein (LRV) compression by the superior mesenteric artery (SMA; nutcracker anatomy). B, The LVR has been transposed and patched with great saphenous vein. C, Stenting of the transposed and patched LRV using a Wallstent (Boston Scientific, Marlborough, Mass). Reproduced by permission of the Mayo Foundation for Medical Education and Research. All rights reserved. The Mayo Clinic does not endorse specific products, advertisers, or services included in this article. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

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