Interventional Radiology, Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Transplant Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Cardiovasc Intervent Radiol. 2024 Sep;47(9):1190-1199. doi: 10.1007/s00270-024-03822-w. Epub 2024 Aug 6.
Left renal vein compression syndrome (LRVCS) remains a challenging diagnosis. This study aimed to correlate imaging and hemodynamic findings with clinical outcomes for patients with LRVCS.
A retrospective review of 66 renal venography procedures with or without intravascular ultrasound (IVUS) was performed from 2017 to 2023 at a single institution. Patients with prior LRVCS treatment or other indications were excluded (n = 11). Primary outcome measure was correlation of catheter-based endovascular (CBE) findings with clinical outcomes (n = 55). Secondary outcome measures included correlation of CBE findings and LRV (i.e., beak) angle > 32°, beak sign, aortomesenteric angle (AMA < 41°), and hilar-to-aortomesenteric ratio (HTAMR ≥ 4.9) on cross sectional imaging. Descriptive statistics, chi-square testing, and ROC analyses were used.
Of the 55 patients, 52 (94.5%) were females (median age 31, range 14-72) and 56.4% (n = 31) had a diagnosis of LRVCS on CBE evaluation. A renocaval pressure gradient of ≥ 3 mmHg, presence of collaterals, and > 50% area stenosis on IVUS were significantly associated with CBE diagnosis of LRVCS (p < 0.001). Surgical treatment (renal autotransplantation or LRV transposition) was recommended to all patients with CBE diagnosis of LRVCS (n = 31). 81.2% (18/22) of patients who underwent surgery reported symptom resolution or improvement. When the cross sectional imaging measurements were compared with CBE evaluation, AMA was the most sensitive (100%), HTAMR and beak sign were highly specific (93.3%), and beak angle was the most predictive (77.4% sensitivity; 86.7% specificity).
CBE diagnosis of LRVCS was highly predictive of surgical candidacy and post-surgical symptom resolution. The presence of collaterals, > 50% area stenosis on IVUS, or a renocaval pressure gradient ≥ 3 mmHg had a significant association with a CBE diagnosis of LRVCS.
左肾静脉压迫综合征（LRVCS）的诊断仍然具有挑战性。本研究旨在对 LRVCS 患者的影像学和血流动力学发现与临床结局进行相关性分析。
对 2017 年至 2023 年在一家机构进行的 66 例肾静脉造影术（有或无血管内超声（IVUS））进行回顾性分析。排除了有 LRVCS 治疗史或其他适应证的患者（n=11）。主要观察指标是导管相关的血管内（CBE）发现与临床结局的相关性（n=55）。次要观察指标包括 CBE 发现与左肾静脉（即鸟嘴）角度＞32°、鸟嘴征、主动脉肠系膜角（AMA＜41°）和肝门至主动脉肠系膜比值（HTAMR≥4.9）在横断面上的相关性。采用描述性统计、卡方检验和 ROC 分析。
55 例患者中，52 例（94.5%）为女性（中位年龄 31 岁，范围 14-72 岁），56.4%（n=31）在 CBE 评估中诊断为 LRVCS。肾静脉-下腔静脉压力梯度≥3mmHg、存在侧支循环和 IVUS 上＞50%的面积狭窄与 CBE 诊断 LRVCS 有显著相关性（p＜0.001）。所有 CBE 诊断为 LRVCS 的患者（n=31）均建议行手术治疗（肾自体移植或左肾静脉转位）。接受 CBE 诊断为 LRVCS 手术治疗的 22 例患者中，81.2%（18/22）报告症状缓解或改善。当将横断面影像学测量值与 CBE 评估进行比较时，AMA 是最敏感的（100%），HTAMR 和鸟嘴征是高度特异的（93.3%），而鸟嘴角是最具预测性的（77.4%的敏感性；86.7%的特异性）。
CBE 对 LRVCS 的诊断对手术适应证和术后症状缓解有高度预测性。IVUS 上存在侧支循环、＞50%的面积狭窄或肾静脉-下腔静脉压力梯度≥3mmHg 与 CBE 诊断 LRVCS 有显著相关性。
