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Nutcracker Syndrome

Updated: Sep 28, 2020

Recently, the doctors at Milford Vascular Institute diagnosed a patient with a very rare form of venous disease. The patient presented with abdominal pain. After some simple testing, Dr. Davis was able to deduce this patient was suffering from nutcracker syndrome.

What is Nutcracker Syndrome?

Nutcracker syndrome occurs when the arteries near the kidney compress the left kidney vein. In most cases, the compression is caused by a pinching of the left renal vein between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome gets its name because this compression is like a nutcracker crushing a nut.

Normally, the left renal vein takes blood from the left kidney and brings it to the inferior vena cava. Compression of the left renal vein can cause blood to flow backward into other nearby veins and make them swell. This causes symptoms like flank pain and blood in urine.

How is Nutcracker Syndrome Detected?

Nutcracker with Flank Pain

Patients typically first present with abdominal pain and bloody urine. The diagnosis of nutcracker syndrome is particularly difficult because it tends to present similarly to gynecologic or urinary issues. To reach a definitive diagnosis of this syndrome, the patient must undergo a CT scan or MRI.

How is Nutcracker Syndrome Treated?

Depending on the age of the patient and level of severity of the disease, it may be recommended the patient does not require immediate intervention. Typically, intervention would only be recommended if the patient is symptomatic.

In severe cases of the disease, patients may be recommended to undergo endovenous stenting or surgery.

A stent is a small mesh tube used to hold open the walls of a vein. During this form of treatment for nutcracker syndrome, a stent is placed inside the compressed renal vein to restore normal blood flow. Stenting is performed under x-ray guidance during a procedure called a venogram.

In very severe cases of nutcracker syndrome, the patient and the doctor may decide surgical intervention is the best treatment option. Surgical treatment for nutcracker syndrome can include removing the left renal vein and reattaching it, or a left renal vein bypass. Bypass surgery is the process of using a bypass graft to reroute blood around a blockage in a blood vessel. Bypass grafts can be made of organic or artificial materials. 

To make an appointment with a member of the leading vascular team in Connecticut, call the office at (203)882-VEIN (8346).

Wishing you all a very happy and healthy holiday season!

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