Use Of Tubularized Bovine Pericardium In Left Renal Vein Transposition For Nutcracker Syndrome
Ruojia D. Li, MD, Bernadette Aulivola, MD.
Loyola University Medical Center, Maywood, IL, USA.
DEMOGRAPHICS: Patient is a 22 yo woman with BMI of 18.
HISTORY: Patient reported a 4-year history of left flank pain and intermittent gross hematuria every 2 weeks. She denied pelvic pain, gastrointestinal or lower extremity symptoms. Urinalysis had RBCs but no infection was noted. Cystoscopy was negative. CT urogram showed left renal vein and duodenal compression between aorta and superior mesenteric artery with a narrow aortic-SMA angle.
PLAN: Patient underwent left renal vein transposition to the distal inferior vena cava via transabdominal approach. Left renal vein was transected at the IVC but length was too short to create a tension-free anastomosis. A bovine pericardium sheet was tubularized and used as an interposition graft. The patient recovered well and is symptom-free.
DISCUSSION: Left renal vein transposition is a well-described surgical technique used in the treatment of Nutcracker Syndrome. Adjunct techniques may be needed to create a tension-free transposition of the renal vein. Use of vein or prosthetic has been described. This case illustrated the use of an alternate conduit for reconstruction. 
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