Most commonly between the aorta and the superior mesenteric artery
Leading to impaired blood outflow often accompanied by distention of the distal portion of the vein
Nutcracker syndrome
Clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations
Incidence
Higher in female
Clinical features
Variable from asymptomatic microhematuria to severe pelvic congestion
Symptoms are often aggravated by physical activity
Hematuria
Pain or gonadal vein syndrome
Varicocele (left)
Orthostatic proteinuria
Orthostatic intolerance
Anatomy
Left renal vein is 6 to 10 cm in length
Unlike the right renal vein, receives tributaries of the left adrenal, left gonadal, ureteral, and communicating second (and occasionally third) lumbar veins before joining the IVC.
These tributaries have valves preventing reflux of the blood. In NCP, when the valves are absent or incompetent, the tributaries may decompress the LRV.
In contrast, the presence of competent valves in NCP may contribute to an increase in renal pressure and resultant formation of varices and collaterals. T
Diagnosis
CT
MRA
Angiography
USS
Management
Conservative
Surgical approaches
Medial nephropexy with excision of renal varicosities,
LRV bypass
LRV transposition with or without Dacron wedge insertion between SMA and aorta