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Case Reports
. 2015 Jul 24:15:73.
doi: 10.1186/s12894-015-0063-0.

Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome

Lu Tian  1 , Shanwen Chen  2 , Gaoyue Zhang  3 , Hongkun Zhang  4 , Wei Jin  5 , Ming Li  6
Affiliations
Case Reports

Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome

Lu Tian et al. BMC Urol. .

Abstract

Background: Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or embolization.

Case presentation: A 30-year-old female was diagnosed with nutcracker syndrome for severe left flank pain. After failed conservative approach, she underwent endovascular stenting and subsequently developed recurrent symptom for stent migration one month postoperatively. She underwent successful extravascular stenting with complete symptom resolution.

Conclusion: The extravascular stenting is an alternative option after migration of left renal vein endovascular stenting. The computed tomographic imaging was closely correlated to therapeutic interventions and stent migration.

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Figures

Fig. 1
Fig. 1
The images of the duplex ultrasound and the left renal venography. a, Right transverse image: Duplex ultrasound demonstrated the compressed left renal vein between the aorta (white arrow) and the superior mesenteric artery (blue arrow), and the left renal vein was pressed like a beak. b, Left transverse image: Duplex ultrasound demonstrated a narrowing of the left renal vein at the aortomesenteric portion and varices of left gonadal vein (green arrow) arising from the left renal vein on the left of aorta (white arrow). c, Before extravascular stenting, left renal venography demonstrated there was obstruction of left renal venous outflow and perihilar varices (red arrow). d, After endovascular stenting (red arrow), left renal venography showed unobstructed blood outflow and full stent expansion without obvious protrusion of the stent in the inferior vena cava
Fig. 2
Fig. 2
The images of the computed tomographic angiography (CTA). a, The second CTA evaluation was suggestive of an endovascular stent migration (red arrow) on the left of the superior mesenteric artery. b, The third CTA demonstrated further migration of the endovascular stent on the left of SMA. c, The follow-up CTA demonstrated the extravascular stent (red arrow) was patent and well positioned, and the endovascular stent (blue arrow) remained on the left of the superior mesenteric artery
Fig. 3
Fig. 3
The images of the extravascular stent placement. a, The migrated endovascular stent was inside the left renal vein (green arrow), and the left adrenal central vein (black arrow) was ligated and transected. The aorta (blue arrow); the inferior vena cava (white arrow). b, Intraoperative photograph demonstrated the graft (black arrow) was wrapped around the renal vein. c, The graft was fixed together at each ring and sewn to the adventitia of the abdominal aorta
See this image and copyright information in PMC

References

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