HUANG Mengju, DI Xiao, XU Weifeng, WANG Xuan, CHEN Yuexin, ZHENG Yuehong. Nutcracker Syndrome with Varicocele Treated with Left Gonadal Vein-inferior Vena Cava Transposition and High Ligation of Spermatic Vein: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 658-663. DOI: 10.12290/xhyxzz.2021-0503
Citation: HUANG Mengju, DI Xiao, XU Weifeng, WANG Xuan, CHEN Yuexin, ZHENG Yuehong. Nutcracker Syndrome with Varicocele Treated with Left Gonadal Vein-inferior Vena Cava Transposition and High Ligation of Spermatic Vein: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 658-663. DOI: 10.12290/xhyxzz.2021-0503

Nutcracker Syndrome with Varicocele Treated with Left Gonadal Vein-inferior Vena Cava Transposition and High Ligation of Spermatic Vein: A Case Report

Funds: 

Natural Science Foundation of Beijing M22028

More Information
  • Corresponding author:

    CHEN Yuexin, E-mail: cyuexin2007@163.com

    ZHENG Yuehong, E-mail: yuehongzheng@yahoo.com

  • Received Date: June 28, 2021
  • Accepted Date: October 11, 2021
  • Available Online: June 10, 2022
  • Issue Publish Date: July 29, 2022
  • Nutcracker syndrome (NCS) is a rare disease that may cause proteinuria, renal dysfunction and varicose of genital veins. Traditional open surgery prefers left renal vein transposition, but this surgical method is more traumatic and patients often have more postoperative short-term and long-term complications affecting the quality of life. This article reports a case of a young male patient with NCS complicated with left varicocele. He was treated with left gonadal vein-inferior vena cava transposition and high ligation of spermatic vein, which achieved good results after surgery. This surgical method provides a new treatment idea for patients with NCS and varicocele, which is worthy of clinical reference.
  • [1]
    He Y, Wu Z, Chen S, et al. Nutcracker syndrome--how well do we know it?[J]. Urology, 2014, 83: 12-17. DOI: 10.1016/j.urology.2013.08.033
    [2]
    Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines[J]. Eur J Vasc Endovasc Surg, 2017, 53: 886-894. DOI: 10.1016/j.ejvs.2017.02.015
    [3]
    Tan AP, Chua BS, Lim KB, et al. Unusual Clinical Presentation of Nutcracker Phenomenon[J]. Ann Acad Med Singap, 2017, 46: 470-471. DOI: 10.47102/annals-acadmedsg.V46N12p470
    [4]
    Hadei SK, Badr S, Amirzargar MA. Refractory hyperten-sion and pelvic pain associated with nutcracker phenomenon[J]. Radiol Case Rep, 2020, 15: 519-522. DOI: 10.1016/j.radcr.2020.01.040
    [5]
    Granata A, Distefano G, Sturiale A, et al. From Nutc-racker Phenomenon to Nutcracker Syndrome: A Pictorial Review[J]. Diagnostics (Basel), 2021, 11: 101. DOI: 10.3390/diagnostics11010101
    [6]
    de Macedo GL, Dos Santos MA, Sarris AB, et al. Diagno-sis and treatment of the Nutcracker syndrome: a review of the last 10 years[J]. J Vasc Bras, 2018, 17: 220-228. DOI: 10.1590/1677-5449.012417
    [7]
    Reddy DK, Shekar PA. Nutcracker Syndrome-A Rare but Important Cause of Varicocele in Adolescent Boys[J]. Urology, 2020, 141: 143-146. DOI: 10.1016/j.urology.2020.04.008
    [8]
    Hao J, Shi H, Xu H, et al. Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele[J]. Int Urol Nephrol, 2019, 51: 1925-1932. DOI: 10.1007/s11255-019-02226-x
    [9]
    Berthelot JM, Douane F, Maugars Y, et al. Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain[J]. Joint Bone Spine, 2017, 84: 557-562. DOI: 10.1016/j.jbspin.2016.10.006
    [10]
    Velasquez CA, Saeyeldin A, Zafar MA, et al. A syste-matic review on management of nutcracker syndrome[J]. J Vasc Surg Venous Lymphat Disord, 2018, 6: 271-278. DOI: 10.1016/j.jvsv.2017.11.005
    [11]
    Dunphy L, Penna M, Tam E, et al. Left renal vein entrapment syndrome: nutcracker syndrome![J]. BMJ Case Rep, 2019, 12: e230877. DOI: 10.1136/bcr-2019-230877
    [12]
    Chau AH, Abdul-Muhsin H, Peng X, et al. Robotic-assisted left renal vein transposition as a novel surgical technique for the treatment of renal nutcracker syndrome[J]. J Vasc Surg Cases Innov Tech, 2018, 4: 31-34. DOI: 10.1016/j.jvscit.2017.09.008
    [13]
    Steinberg RL, Johnson BA, Garbens A, et al. Robotic assisted extravascular stent placement for nutcracker phenomenon of the left renal vein: a case series[J]. J Robot Surg, 2020, 14: 781-788. DOI: 10.1007/s11701-020-01054-x
    [14]
    Wang H, Guo YT, Jiao Y, et al. A minimally invasive alternative for the treatment of nutcracker syndrome using individualized three-dimensional printed extravascular titanium stents[J]. Chin Med J (Engl), 2019, 132: 1454-1460. DOI: 10.1097/CM9.0000000000000255
    [15]
    He D, Liang J, Wang H, et al. 3D-Printed PEEK Extravascular Stent in the Treatment of Nutcracker Syndrome: Imaging Evaluation and Short-Term Clinical Outcome[J]. Front Bioeng Biotechnol, 2020, 8: 732. DOI: 10.3389/fbioe.2020.00732
    [16]
    Gilmore BF, Benrashid E, Geersen D, et al. Gonadal vein transposition is a safe and effective treatment of nutcracker syndrome[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9: 712-719. DOI: 10.1016/j.jvsv.2020.09.002
    [17]
    Leal Monedero J, Zubicoa Ezpeleta S, Perrin M. Management of left renal vein compression in patients presenting left gonadal vein reflux[J]. Phlebology, 2018, 33: 475-482. DOI: 10.1177/0268355517723992
    [18]
    Korkes F, Silveira M, Neves-Neto OC, et al. Nutcracker Syndrome: laparoscopic external stenting of the renal vein ("the shield technique")[J]. Int Braz J Urol, 2017, 43: 373. DOI: 10.1590/s1677-5538.ibju.2015.0666
    [19]
    Cronan JC, Hawkins CM, Kennedy SS, et al. Endova-scular management of nutcracker syndrome in an adolescent patient population[J]. Pediatr Radiol, 2021, 51: 1487-1496. DOI: 10.1007/s00247-021-04986-0
    [20]
    Avgerinos ED, Saadeddin Z, Humar R, et al. Outcomes of left renal vein stenting in patients with nutcracker syndrome[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7: 853-859. DOI: 10.1016/j.jvsv.2019.06.016
    [21]
    Wu Z, Zheng X, He Y, et al. Stent migration after endovascular stenting in patients with nutcracker syndrome[J]. J Vasc Surg Venous Lymphat Disord, 2016, 4: 193-199. DOI: 10.1016/j.jvsv.2015.10.005
    [22]
    Gong XY, Zheng W, Du H, et al. Treatment of nutcracker syndrome with spermatic vein ligation and iliac vein anastomosis: Case report of three cases[J]. Asian Pac J Trop Med, 2012, 5: 923-924. DOI: 10.1016/S1995-7645(12)60174-6
    [23]
    Debucquois A, Salomon du Mont L, Bertho W, et al. Current results of left gonadal vein transposition to treat nutcracker syndrome[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9: 1504-1509. DOI: 10.1016/j.jvsv.2021.03.003
    [24]
    Miler R, Shang EK, Park WM. Gonadal Vein Transposi-tion in Nutcracker Syndrome[J]. Ann Vasc Surg, 2018, 46: 205. e13-205. e16. DOI: 10.1016/j.avsg.2017.06.153
  • Related Articles

    [1]Society of Gynecologic Oncology, Chinese Medical Association, Branch of Colposcopy and Cervical Pathology, China Healthy Birth Science Association, Professional Committee on Cancer Prevention and Control, Chinese Preventive Medicine Association, Specialized Committee on Cervical Cancer Prevention and Control Research, China Maternal and Child Health Research Association, National Collaborative Group for Cervical Cancer Prevention and Treatment, China Cancer Foundation, Committee on Cervical Cancer, China Anti-Cancer Association, Branch of Obstetric and Gynecological Health Medicine, China International Exchange and Promotive Association for Medical and Health Care. Preventive Human Papilloma Virus Vaccine Guidelines for Clinical Use in China(2025 edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2025, 16(2): 350-360. DOI: 10.12290/xhyxzz.2025-0246
    [2]YIXI Jinba, WANG Gaoxue, BASANG Ciren, GASONG Zhuoga, PU Zhi, CIREN Yangjin, BIAN Zhen, LIU Zhijuan, DU Juan. HPV Survey and Analysis of Women in Xizang[J]. Medical Journal of Peking Union Medical College Hospital. DOI: 10.12290/xhyxzz.2024-0914
    [3]CHEN Yuqing, LI Jinming. Virological Characteristics of the Omicron Variant: Key Mutations, Pathogenicity, and Immune Escape[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 945-952. DOI: 10.12290/xhyxzz.2023-0139
    [4]WANG Xiaodan, ZHANG Zhan, LIU Zhaohui. Analysis of Influencing Factors for High-risk Human Papillomavirus Infection[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(1): 153-158. DOI: 10.12290/xhyxzz.2022-0193
    [5]LIANG Li. Interpretation on The Consensus Among Chinese Experts About Acquisition and Quality Control of Digital Pathological Images in Cervical Liquid Based Cytology[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 571-573. DOI: 10.12290/xhyxzz.2022-0100
    [6]LIU Yanting, ZHANG Lu, CHEN Miao, ZHANG Yan, WEI Chong, PAN Boju, ZHAO Jiawei. A Case of Small B-cell Lymphocytic Lymphoma Diagnosed One Year after Evans Syndrome[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(3): 423-426. DOI: 10.12290/xhyxzz.20200063
    [7]Gynecological Oncology Society of Chinese Medical Association, Chinese Society for Colposcopy and Cervical Pathology. Chinese Expert Consensus on Clinical Application of Human Papilloma Virus Vaccine[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 189-201. DOI: 10.12290/xhyxzz.2021-0082
    [8]Dong XU, Feng-chun ZHANG. Systemic Lupus Erythematosus, Human Papilloma Virus Infection and Vaccine[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(3): 252-257. DOI: 10.3969/j.issn.1674-9081.20200042
    [9]Hong-zhi GUAN, Lin CHEN, Zhi-yong LIANG, Ding-rong ZHONG, Jian LI, Wei CUI, Min QIAN, Hai-tao REN, Qing LING, Xuan WANG, Yan-huan ZHAO, Yu-pu GUO. Role of Cerebrospinal Fluid Cytology in Diagnosis of Primary Central Nervous System Lymphoma[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(3): 273-278. DOI: 10.3969/j.issn.1674-9081.2012.03.006
    [10]Lu-lu SUN, Dong-yan CAO, Jia-xin YANG, Mei-lu BIAN, Li-hui WEI, Li YANG, Ning-hai CHENG, Yi YANG, You-fang WANG, Xue-mei CHENG, Li-jun HU, Jie CHEN, Jing-he LANG, Keng SHEN. Value-based Medicine of Loop Electrosurgical Excision Procedure and CO2 Laser Vaporization for Cervical Intraepithelial Neoplasia 2[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(2): 129-133. DOI: 10.3969/j.issn.1674-9081.2011.02.008
  • Cited by

    Periodical cited type(2)

    1. 赵世豪,王俊涛,陈宽,王茜,王红玲,王文慧,梁宇聪,王祥麒. 国医大师唐祖宣治疗前列腺癌经验. 中医学报. 2025(02): 377-382 .
    2. 李宗霖,卢强,李远伟. 尿液代谢组学在前列腺癌中的应用研究进展. 中国现代医学杂志. 2024(08): 40-44 .

    Other cited types(0)

Catalog

    Article Metrics

    Article views PDF downloads Cited by(2)
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return
    x Close Forever Close