Left renal vein nutcracker syndrome and concurrent IVC duplication: Surgical treatment

• Authors: Eric Midenberg, Emory University; Rajeev Subu, Emory University; Aarti Sekhar, Emory University; Brendan Browne, Emory University; Yazan Duwayri, Emory University; Viraj Master, Emory University
• Journal Title: Urology Case Reports
• Volume: Volume 39
• Publisher: Elsevier | 2021-11-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.eucr.2021.101819
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Nutcracker syndrome; IVC Duplication; Hematuria; Congenital anomalies

Abstract

Multiple vascular anomalies may be encountered in patients with nutcracker syndrome; further compounding the surgical complexity in managing this condition. A 28-year-old male presented with persistent flank pain and hematuria. Imaging revealed narrowing of the left renal vein at the aortomesenteric junction, and a dilated vein consistent with the left gonadal vein. On surgical exploration, a duplicated IVC was found. The patient underwent a right caval-to-left caval bypass using a cryopreserved femoral vein homograft. The surgery was well tolerated and completely resolved the patient's symptoms.