Nutcracker Syndrome

Nutcracker Syndrome Surgery Treatment in Hyderabad, India

A vein compression disorder called nutcracker syndrome occurs in rare cases. The left renal vein becomes compressed when an artery, usually the aorta and superior mesenteric artery of the abdomen, squeezes it.

As well as flank pain and blood in the urine, it can cause a variety of symptoms in both children and adults. A stenting procedure, surgery, and routine urine tests are most commonly used to treat nutcracker syndrome.

The CARE Hospital’s Vascular Surgery Division uses the latest techniques in treating nutcracker syndrome. Our team of physicians takes a team approach in diagnosing your condition and making sure you get the best treatment.

What is nutcracker syndrome caused by?

Nutcracker syndrome is primarily caused by the anatomical compression of the left renal vein between two structures in the abdomen, specifically the abdominal aorta and the superior mesenteric artery. This compression can result in increased pressure within the left renal vein, leading to various symptoms and potential complications.

The name "nutcracker" is derived from the analogy of the compression between the aorta and the mesenteric artery, resembling the action of a nutcracker on a nut. The exact cause of the compression can vary among individuals, and factors contributing to nutcracker syndrome may include:

• Aortomesenteric Angle: The acute angle formed between the abdominal aorta and the superior mesenteric artery can influence the degree of compression on the left renal vein. A smaller angle may increase the risk of compression.
• Nutcracker Phenomenon: This term is sometimes used interchangeably with nutcracker syndrome. The phenomenon refers to the presence of the anatomical compression without the development of symptoms or complications. Nutcracker syndrome occurs when this compression leads to clinical manifestations.
• Abnormal Anatomy: Variations in the course or position of blood vessels, such as a retroaortic left renal vein, can contribute to the compression and subsequent symptoms of nutcracker syndrome.
• Nutcracker Syndrome Secondary to Other Conditions: In some cases, nutcracker syndrome may be secondary to other conditions, such as tumors or cysts near the renal vessels, which contribute to the compression.

Nutcracker Syndrome Symptoms

• Nutcracker syndrome symptoms: Symptoms of Nutcracker syndrome differ depending on the age of the patient, but some people - especially children - have no symptoms. Nutcracker syndrome is characterised by the following symptoms:

  • Pain in the abdomen (flank pain).

  • Blood in the urine (haematuria).

  • The pelvis or genital area may feel heavy and painful due to congestion in the pelvis, or varicose veins in the lower abdomen.

  • Women may experience pain during sexual activity.

  • Symptoms include varicoceles in men (enlarged veins in the scrotum).

These are some of the other symptoms of the nutcracker phenomenon:

• Legs with varicose veins.

• Extreme cramping during menstruation.

• Pain when urinating.

• Varicose veins in the gluteus and vulva.

• Lack of energy.

Nutcracker syndrome diagnosis

Due to its symptoms being similar to those of other urological and gynecologic disorders,  nutcracker syndrome can be difficult to diagnose. Nutcracker syndrome is often diagnosed after ruling out other conditions. Doctors at CARE Hospitals will perform the following tests to diagnose nutcracker syndrome:

• We can discuss your symptoms with you.

• We can review your medical history.

• We can examine you.

A doctor at CARE Hospitals will also consider any physical abnormalities or differences when diagnosing nutcracker syndrome.

Your physician will perform the following tests in order to rule out other common renal conditions:

• Blood exam

• Urinalysis

• Urine culture

• Cytology

• Urethrocystoscopy

• CT urography

• Renal biopsy

To confirm the diagnosis of nutcracker syndrome, your doctor may order tests such as:

• You can take pictures of the blood flowing through your veins using a Doppler ultrasound, which uses ultrasound waves.

• CT scan - a technique that uses x-rays and a computer to create detailed 3D images.

• MRI - which creates detailed images of your veins using a large magnetic field, radio waves, and computers.

Nutcracker Syndrome Treatment

Treatment for nutcracker syndrome depends on your age, the severity of your symptoms, and your overall health.

Depending on your condition, you may not need treatment, particularly if you are:

• If you are 18 or younger, the condition may resolve as you grow older.

• A person with mild symptoms of nutcracker syndrome.

Nutcracker syndrome is most commonly treated with:

• Stenting

• Surgery

• Routine urinalysis

The doctors at CARE Hospitals will discuss each option with you.

Stenting to treat nutcracker syndrome

During the treatment of your nutcracker syndrome, your surgeon may use a stent - a small mesh tube - to hold your left renal vein open and allow proper blood flow.

In order to place the stent in your vein, your surgeon will:

• Create a small puncture in your leg.
• A thin, flexible tube called a catheter is inserted into your vein along with a guidewire.
• Stents are then expanded to hold the vein open.

Usually, you’ll stay in the hospital overnight following the procedure.

Surgical treatment for Nutcracker syndrome

Your doctor may recommend vascular surgery to relieve the pressure on your left renal vein if you have severe nutcracker syndrome. Nutcracker syndrome can be treated surgically by moving the left renal vein and reconnecting it, or by performing a left renal vein bypass.

The following reasons might lead your doctor to recommend nutcracker syndrome surgery:

• Anaemia is caused by recurrent or persistent blood in the urine (haematuria).

• An abdominal pain (flank pain) is caused by blood clots.

• Severe pain.

• The condition seems to remain unchanged after 24 months.

Natural treatments for nutcracker syndrome

Those experiencing mild symptoms of the nutcracker phenomenon may opt to postpone invasive treatments and have regular urinalysis tests performed to monitor the condition. You may choose this option if you want your doctor to monitor your condition with regular urinalysis.

In this instance, your doctor will be able to tell you if the condition improves on its own, or when to take further steps, with regular urinalysis.

Nutcracker syndrome recovery time and prognosis

• Stenting: Stenting for nutcracker syndrome can take up to two months to recover from. The stent will be accepted by the body and new tissue will surround it after that.
• Surgery: It may take 3 months for the vein and/or artery to heal after Nutcracker syndrome surgery.

The symptoms of nutcracker syndrome are generally relieved immediately in cases of severe cases. However, mild cases are less likely to show any improvement.