Spiral saphenous vein graft for left renal vein reconstruction after endovascular failure in the treatment of nutcracker syndrome.

Abstract

Nutcracker syndrome (NS) is caused by compression of the left renal vein (LRV) between the aorta and superior mesenteric artery. Symptoms include hematuria, flank pain, and chronic fatigue.1 A 15-year-old female was consulted for definitive management of NS. Two years ago, she started experiencing fatigue, headaches, nausea, and flank pain. Workup revealed NS, and she underwent endovascular LRV stenting at another institution, achieving complete symptoms resolution. Three months later, symptoms recurred, and she required two reinterventions, elsewhere, with venography and balloon angioplasty due to stent thrombosis.