Endovascular approach for nutcracker syndrome using an arterial stent: The first Latin-American experience

Objective

The exact prevalence of nutcracker syndrome (NCS) is unknown, due to the very low incidence of this disease plus the absence of definitive diagnostic criteria. Some authors have reported a higher prevalence of this condition in women, however published and available information is limited. Due to symptoms and consequences that can cause, it is important to suspect it and diagnose it. The aim of this study was to report the outcomes of the first Latin-American experience in the treatment of NCS using an endovascular approach with a left renal vein (LRV) balloon and arterial stent angioplasty.

Methods

The study design was a retrospective cohort analysis of 11 patients who underwent endovascular approach with LRV balloon and arterial stent angioplasty for the treatment of NCS between January 2019 and April 2022 in Bogota, Colombia.

Results

During January 2019 to April 2022, 553 patients were treated for congestive pelvic syndrome. Only 11 patients have clinical criteria (hematuria, varicose pelvic veins, and left flank pain), imaging diagnostic criteria (abdominal veins Doppler ultrasound or abdominal computed tomography with superior mesentery artery – abdominal aorta angle <39°) and an average of LRV – inferior vena cava pressure measurement comparison difference of 6 mmHg for NCS. The 100% were female patients. All the patients were under 65 years and underwent endovascular approach (EVA) with LRV balloon and arterial stent angioplasty. The 100% of patients presented resolution of the collateral vein circulation in the final control phlebo-cavography. The average age was 46.5 years old. Ten patients had an anterior type of NCS and only 1 had a posterior type of NCS. None of the patients had NCS due to secondary causes such as pancreatic head tumors.

Conclusions

This study shows that the endovascular approach with LRV balloon and arterial stent angioplasty is a safe and cost-effective treatment for NCS with low incidence of complications and no need of postoperative reintervention in short and middle term follow-up.