Ovarian Vein Transposition For Nutcracker Syndrome
Kaled Diab, MD, Philip Auyang, MD, Charudatta Bavare, MD
Houston Methodist, Houston, TX
DEMOGRAPHICS: This case report focuses on patients diagnosed with Nutcracker syndrome who underwent ovarian vein transposition for symptom relief.
HISTORY: Nutcracker syndrome is a rare disorder characterized by a complex of symptoms with significant variations. The frequency as well as the severity of the syndrome can vary from asymptomatic hematuria to symptoms of severe pelvic congestion. Symptoms include but are not limited to flank pain, pelvic pain, varicose veins in the lower abdomen, and pelvic heaviness.In some cases, these symptoms can be debilitating and significantly effects the patient's quality of life. Historically surgical treatment has been described as renal vein transposition with the anastomosis being at least 5 cm caudal to the origin of the left renal vein. However, this often results in an anastomosis under tension and is susceptible to thrombosis. We aim to describe the alternative gonadal vein transposition as a superior surgical technique that should replace renal vein transposition as the treatment of choice.
PLAN: This case report illustrates a retrospective review of 3 ovarian vein transposition cases performed between May 2018 and September 2019. We will include an in-depth description of the diagnostic workup necessary including CT imaging as well as venography with reno-caval pressure gradient measurements. Additionally, the procedure itself will be described in detail and a video can be provided illustrating one of the 3 cases of ovarian vein transposition to demonstrate the surgical technique. Lastly, follow up and outcomes will be discussed.
DISCUSSION: We demonstrate a 100% success rate. Of note, two of the cases were performed after failed renal vein transposition and patients experienced complete resolution of symptoms afterwards.Ovarian vein transposition is demonstrated to be an excellent therapeutic option to treat nutcracker left renal vein compression. Ovarian vein transposition results in a tension free anastomosis. The procedure is less morbid than renal vein transposition and requires only one anastomosis, does not require any vein cuff or vein harvest from other sites. The procedure also effectively eliminates pelvic congestion syndrome and affords relief from other symptoms associated with nutcracker phenomenon.
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