Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Results of surgical treatment for patients with Nutcracker syndrome

Authors: Arakelyan V.S., Papitashvili V.G., Gamzaev N.R., Nikogosyan M.M., Shumilina M.V., Chernykh N.A., Shilkin D.N.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2024-21-4-332-343

UDC: 616.146.2-007.271-089

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (4): 332-343

Quote as: Arakelyan V.S., Papitashvili V.G., Gamzaev N.R., Nikogosyan M.M., Shumilina M.V., Chernykh N.A., Shilkin D.N. Results of surgical treatment for patients with Nutcracker syndrome. Clinical Physiology of Circulation. 2024; 21 (4): 332–343 (in Russ.). DOI: 10.24022/1814-6910-2024-21-4-332-343

Received / Accepted:  13.10.2024 / 27.10.2024

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Abstract

Objective. To evaluate the results of surgical treatment of patients with “Nutcracker syndrome”.

Material and methods. A single-center prospective controlled study included 42 operated patients. The median age of the patients was 18 years, with an interquartile range from 16 to 31 years, comprising 24 men (57%) and 18 women (43%). The most common reasons for seeking medical attention included the following symptoms:

renovascular hypertension in 30 (71%) patients,

hematuria and orthostatic proteinuria in 21 (50%) and 15 (36%) cases, respectively,

girdle pain in 16 (38%) patients, abdominal pain in 10 (24%), and varicocele/ovarian varicosities in 17 (40.5%).

All operated patients underwent a standard set of laboratory and instrumental investigations, including a complete blood count and urinalysis, biochemical blood analysis, ultrasound of renal vessels, contrast-enhanced multi-slice computed tomography (MSCT), aortography with venous phase imaging, and phlebography with pressure measurement in the inferior vena cava and left renal vein. In 100% of cases, planned surgical treatment was performed—translocation of the left renal vein to the infrarenal segment of the inferior vena cava.

Results. An immediate positive treatment outcome is observed in 100% of the initially operated patients with nutcracker syndrome, as evidenced by the restoration of normal lumen in the left renal vein according to follow-up MSCT and ultrasound results. In the early postoperative period, there were no fatalities or complications that affected hospitalization duration. The follow-up period ranged from 6 to 24 months (with an average follow-up duration of 14.4 ± 3.6 months). In 7 patients (16.7%), restenosis at the anastomosis site was detected at various times after surgery, associated with persistent clinical symptoms. Reoperation was required for two out of the seven patients.

Conclusion. Translocation of the left renal vein to the infrarenal segment of the inferior vena cava is a safe and effective method for treating symptomatic patients with nutcracker syndrome. The identified cases of symptom recurrence in the late postoperative period indicate the need for an individualized approach to planning the surgical technique for renal vein translocation, as well as the consideration of alternative surgical treatment methods.

About Authors

  • Valeriy S. Arakelyan, Dr. Med. Sci., Professor, Head of the Department of Surgery of Arterial Pathology, Cardiovascular Surgeon; ORCID
  • Vasil G. Papitashvili, Dr. Med. Sci., Cardiovascular Surgeon, Head of the Department of Surgery of the Main and Peripheral Arteries; ORCID
  • Nazim R. Gamzaev, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Marta M. Nikogosyan, Applicant, Cardiovascular Surgeon; ORCID
  • Margarita V. Shumilina, Dr. Med. Sci., Professor, Head of the Ultrasound Diagnostics Group of Cardiovascular and Organ Pathology; ORCID
  • Nikolay A. Chernykh, Researcher, Cardiovascular Surgeon; ORCID
  • Dmitriy N. Shilkin, Cardiovascular Surgeon; ORCID

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