Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
Division of Pediatric Radiology, Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA, USA.
Pediatr Radiol. 2021 Jul;51(8):1487-1496. doi: 10.1007/s00247-021-04986-0. Epub 2021 Mar 11.
Nutcracker syndrome is defined as left renal vein compression with concomitant clinical symptoms that include flank pain and hematuria. Historically, pediatric and adolescent patients with mild symptoms of nutcracker syndrome were simply observed while those with more severe symptoms underwent left renal vein transposition. Endovascular stenting of the left renal vein is a potentially efficacious and less invasive alternative for managing nutcracker syndrome in adolescents.
The purpose of this study was to investigate the technical feasibility, efficacy and safety of left renal vein stenting in adolescents with nutcracker syndrome.
We conducted a retrospective review of electronic medical records and imaging archives to identify adolescents undergoing endovascular stenting for nutcracker syndrome. We reviewed patient demographics including age, gender, presenting symptoms and diagnostic imaging findings. We compared pre- and post-stent deployment intravascular ultrasound (IVUS) and venography and evaluated patient symptoms in clinic up to 6 months following stent placement.
Ten patients (average age 16 years, range 12-20 years) underwent 13 procedures. Initial symptoms included pain (n=10) and gross hematuria (n=5). Diagnostic imaging studies included CT abdomen pelvis (n=8), retroperitoneal US (n=6), MRI abdomen/pelvis (n=4), scrotal US (n=2), pelvic US (n=1) and renal Doppler US (n=2). Venography and IVUS demonstrated venous collaterals, proximal blanching at the left-renal-vein-IVC junction, pre-stenotic dilation and intraluminal compression. Most patients (n=9) experienced symptomatic resolution; however, three patients required reintervention to achieve asymptomatic status. No periprocedural complications occurred.
In this carefully selected adolescent cohort, left renal vein stenting for nutcracker syndrome was often technically feasible, safe and effective in symptom management.
胡桃夹综合征是指左肾静脉受压，同时伴有腰痛和血尿等临床症状。历史上，对于有轻度胡桃夹综合征症状的儿科和青少年患者，通常只需观察，而对于有更严重症状的患者，则进行左肾静脉转位术。左肾静脉支架置入术是一种治疗青少年胡桃夹综合征的有效且微创的替代方法。
本研究旨在探讨青少年胡桃夹综合征患者左肾静脉支架置入术的技术可行性、疗效和安全性。
我们对电子病历和影像学档案进行了回顾性分析，以确定接受血管内支架置入术治疗胡桃夹综合征的青少年患者。我们回顾了患者的人口统计学资料，包括年龄、性别、临床表现和诊断性影像学检查结果。我们比较了支架置入前后的血管内超声（IVUS）和静脉造影，并在支架置入后 6 个月内对患者的症状进行了门诊评估。
10 例患者（平均年龄 16 岁，范围 12-20 岁）共进行了 13 次手术。初始症状包括疼痛（n=10）和肉眼血尿（n=5）。诊断性影像学检查包括腹部盆腔 CT（n=8）、腹膜后超声（n=6）、腹部/盆腔 MRI（n=4）、阴囊超声（n=2）、盆腔超声（n=1）和肾多普勒超声（n=2）。静脉造影和 IVUS 显示静脉侧支循环、左肾静脉-IVC 交界处近端变白、狭窄前扩张和腔内压迫。大多数患者（n=9）症状得到缓解，但 3 例患者需要再次干预以达到无症状状态。无围手术期并发症发生。
在这组经过精心选择的青少年患者中，左肾静脉支架置入术治疗胡桃夹综合征通常是可行的、安全的，并且在症状管理方面是有效的。
