Ovarian Vein to External Iliac Vein Transposition: A Simpler Decompression of Nutcracker Syndrome

Abstract

Nutcracker syndrome represents the constellation of symptoms caused by extrinsic compression of the left renal vein between the aorta and superior mesenteric artery, producing left renal venous outflow obstruction and, frequently, pelvic venous congestion. To relieve the reflux, different treatment modalities are available, including renal vein stenting and transposition of the ovarian vein to the inferior vena cava. We have presented a video of our technique of decompression of nutcracker syndrome by transposing the left ovarian vein onto the left external iliac vein. Transposition of the left ovarian vein onto the left external iliac vein is a simpler technique, with limited morbidity. The patients recover more quickly and experience sustained relief of symptoms. The technique also avoids the morbidity of a large open abdominal procedure, the use of prosthetic materials, and stents. We have demonstrated a promising technique that could possibly be adapted as the standard of care for nutcracker syndrome in selected patients.