Nutcracker syndrome is a venous compressive disorder that can cause abdominal, pelvic, or flank pain. It occurs due to compression of the left renal vein between the superior mesenteric artery and the aorta or occasionally between the aorta and the spine. While often incidental, this compression can lead to painful dilated veins in the pelvis and, in severe cases, kidney problems.
Talk to a Doctor
Patients experiencing abdominal or pelvic pain that could be left renal vein compression should discuss their symptoms with a healthcare provider. Referral to a vascular surgeon may be necessary for further evaluation and management.
Role of Vascular Surgeon
Vascular surgeons specialize in diagnosing and treating venous and arterial diseases. They can order follow-up testing, such as abdominal venous duplex. Vascular surgeons also may perform venogram, intravascular ultrasound, stenting, or surgery. Providing reassurance is also a crucial aspect of their role, as invasive treatment is not always necessary.
Diagnosis
Diagnosis of nutcracker syndrome involves imaging studies, such as CT scan or MRI, to visualize left renal vein compression. Additional testing, including abdominal venous duplex, may be ordered by a vascular surgeon for confirmation.
Treatment options for nutcracker syndrome include:
- Counseling
- Observation
- Endovascular management (such as coil embolization or stenting)
- Complex surgery for advanced cases
However, intervention usually is recommended only when patient symptoms are severe, and the patient is a good candidate for treatment.