Antiplatelet therapy patients scheduled to undergo elective stent or flowdiversion device placement receive aspirin 325 mg by mouth daily and clopidogrel 75 mg by mouth daily for a minimum of 4 days before the procedure. The term posterior nutcracker phenomenon refers to the compression of the retroaortic left renal vein between the aorta a and b, arrowhead and the vertebral column a and b, arrow. The retroaortic or circumaortic renal vein may be compressed between the aorta. Flaired 7 mm x 30 mm flair endovascular stent graft. To update our experience with thoracic aortic stentgraft treatment over a 5year period, with special consideration for the occurrence and management of complications. It is similar to the approach used for a cardiac catheterization of the coronary arteries. Stents in the renal vein can cause fibromuscular hyperplasia. Doppler ultrasound, computed tomography angiography and selective renal vein phlebography revealed the compression of the left renal vein by the abdominal aorta. It can be easily overlooked, and should be considered in young men or women with symptoms of extended duration. Reconsideration of endovascular treatment was made after the neuroform selfexpanding intracranial stent boston scientifictarget therapeutics became available. Lmt, a ukbased manufacturer of endovascular stent grafts and other vascular products, announced on tuesday that ian ardill was appointed as its chief financial officer with effect from 23 january 2012. An endovascular stent graft repair is a treatment for aneurysms of the descending thoracic and abdominal aorta.
Intracranial atherosclerotic disease icad is the narrowing of the arteries inside the head that supply blood to the brain. Description intracranial atherosclerotic disease icad is the narrowing of the arteries inside the head that supply blood to the brain. Endovascular stenting for the nutcracker phenomenon. Chen et al have shown, in a longer followup of 61 patients, that endovascular stenting is a primary option for ncs. Privileges in vascular surgery service stanford hospital. Diagnosis of nutcracker phenomenon should be considered in. Endovascular interventions involve the use of stents to. A metaanalysis of case series nassir rostambeigi, david hunter, sue duval, srinath chinnakotla, jafar golzarian. Wideneck intracranial aneurysms were originally thought to be either untreatable or very challenging to treat by endovascular means because of the risk of coil protrusion into the parent vessel. This study aims to report the outcomes of nitinol and polytetrafluoroethylene covered stent placement to treat hemodialysis arteriovenous access stenosis at a single center over a fiveyear period. Learn about the symptoms and treatments for this vascular disease. The nitinol stent is encapsulated with eptfe along the entire length, except the flared stent graft ends with the radiopaque tantalum markers. Read surgical and endovascular interventions for nutcracker syndrome, seminars in vascular surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in males and females alike.
Renal nutcracker syndrome genetic and rare diseases. Endovascular approach with stent implantation has been reported as a. Images c and d show stent placement ct images in the axial and coronal plane, respectively. Nutcracker phenomenon refers to compression of the left renal vein, most commonly. Expanding metallic stent placement for nutcracker phenomenon.
The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa with some imagination appear to be a nutcracker crushing a nut the. Looking at it from a transverse plane both sma and aorta. This procedure requires only small incisions in the groin. Branched thoracic endovascular grafts for the treatment of. A typical case of nutcracker phenomenon journal of vascular. Meissner the nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. A stent is a cylinderlike tube made of thin metalmesh framework used to hold the artery open. The flexive cobaltchromium endovascular stent system is the new treatment option for tortuous iliac lesions. The stent graft is available in a range of diameters and lengths as shown in table 1. Endovascular stenting for nutcracker syndrome sciencedirect. Expandable metallic stent placement for nutcracker. Longterm followup after endovascular stent placement for treatment of nutcracker syndrome.
Nutcracker syndrome an overview sciencedirect topics. Although the use of stents within the venous circulation bears potential risks, such as in stent stenosis and occlusion, experience gained in treating superior vena caval syndrome and buddchiari syndrome, 10 x 10 segawa, n. Endovascular stent and stentgraft placement with adjunctive therapy for arterial disease coverage, coding and reimbursement overview hospitalasc 2017 edition all reimbursement amounts are listed at national medicare rates and do not include the 2% sequestration reduction hospital facility overview coverage. Left renal vein lrv compression by the aorta and the superior mesenteric artery sma leading to symptoms of hematuria or left flank pain has been classically described as nutcracker syndrome ncs 1, 2. Jun 22, 2017 renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. A patient presented with recurrent macroscopic hematuria, persistent orthostatic proteinuria and intermittent flank pain for 12 months. Endovascular management of nutcracker syndrome after. To present a case highlighting the efficacy of stent implantation for left renal vein lrv entrapment, otherwise known as the nutcracker phenomenon. Endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients. Engorged left renal and gonadal veins white arrow in a and b before stenting.
Herein, the authors report three pediatric cases with successful followup for 2 or 3 years after intravenous stent placement with nutcracker syndrome. It was described for the first time in 1996 by neste et al. Renal compression was relieved by external stent es in two patients, internal. Involving a puncture or cut of the skin without exposing the internal organs. Minimal invasive management includes both endovascular stenting and extravascular stenting 1, 2. This entity is better known through its anterior variant, the anterior nutcracker phenomenon, where the anterior left renal vein is compressed between the aorta and the superior mesenteric artery. Endovascular stent placement for hemodialysis arteriovenous. In most cases, youll stay in the hospital overnight after the procedure. Once the diagnosis of a typical nutcracker syndrome was established. Rutherfords vascular surgery and endovascular therapy, 2. Carotid stenting 10 procedures within the previous 2 years case log required.
Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures. Dec 01, 20 read surgical and endovascular interventions for nutcracker syndrome, seminars in vascular surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Endovascular therapy provides an alternative therapy with satisfactory longterm clinical and imaging results for symptomatic patients with nutcracker syndrome. Endovascular stenting for the nutcracker phenomenon is safe and effective and may represent a valuable approach for lessening the morbidity of surgical procedures. Vascular geometry change because of endovascular stent. Vascular geometry change because of endovascular stent placement for anterior communicating artery aneurysms q. Endovascular angioplasty with stenting cas treatment. Endovascular stent placement for the treatment of nutcracker.
Nutcracker syndrome, endovascular stent, hematuria. Endovascular stenting for nutcracker syndrome kuokang feng. May thurner and nutcracker syndrome are examples of venous compression. Renal vein entrapment the nutcracker syndrome brandon t. Complications after endovascular stentgrafting of thoracic.
Nutcracker phenomenon and nutcracker syndrome ncbi. The placement of an expandable metallic stent in the renal vein for the nutcracker phenomena was first described by neste et al. Endovascular stent placement for nutcracker phenomenon ios. Endovascular treatment of nutcracker syndrome request pdf. Endovascular angioplasty with stenting is an option for patients with carotid stenosis who are high risk for carotid endarterectomy or who cannot undergo surgery. If hematuria is not present it is termed nutcracker phenomenon. Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta, leading to symptoms of hematuria and left flank pain. The patient must remain in this position until the pelvic veins are visualized. Endovascular stent placement for nutcracker phenomenon.
Renal vein stenting for nutcracker syndrome endovascular. Endovascular stent placement as a treatment for renal venous hypertension. This document replaces previous guidance on endovascular stent insertion for intracranial atherosclerotic disease nice interventional procedure guidance ipg 233, october 2007. Flexive balloon expandable stent for iliac arteries.
A novel endovascular treatment of a widenecked basilar. Endovascular stent and stentgraft placement with adjunctive. The nutcracker syndrome results from compression of the left renal vein between the aorta and the superior mesenteric artery. Ct images of the lrv before and after endovascular stenting.
Several case reports have proved the usefulness of endovascular stent placement in adults with nutcracker syndrome since 1996 2, 3, 4, 6. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. The patient was diagnosed with nutcracker syndrome and underwent. Nutcracker syndrome is a clinical condition that results from venous.
Because there is a risk of stroke from bits of plaque breaking off during the procedure, an apparatus, called an embolic protection device, may be used. Stent placement versus angioplasty for hepatic artery stenosis after liver transplant. Surgical and endovascular interventions for nutcracker. This highly visible cobalt chromium stent with thin struts is designed to provide outstanding flexibility and conformability. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. Flaired 6 mm x 70 mm flair endovascular stent graft.
From december 2000 to june 2006, 52 patients with thoracic aortic pathologies underwent endovascular repair. Jul 24, 2015 the fourth, fifth and sixth cta demonstrated the extravascular stent was patent and well positioned, and the endovascular stent remained to be on the left of the superior mesenteric artery at the first week, third month, and ninth month after extravascular stent placement respectively fig. Published in association with the society for vascular surgery, this stateoftheart reference by drs. Endovascular procedures, including balloon dilation, stenting and stentgrafting residency in vascular surgery which included this training documentation required or acgme fellowship in vascular surgery or completed 3 month mini fellowship in vascular surgery. Mesoaortic compression of the left renal vein nutcracker syndrome produces. A new variant of the posterior nutcracker phenomenon. Some people may not have symptoms, while others develop severe and persistent symptoms. Lrv and gonadal veins with decreased diameter white arrow in c and d. Hemodynamics have been shown to play an important role in the initiation and progress of intracranial aneurysms, and are considered wellrelated to vascular. Chiesa r1, anzuini a, marone em, briguori c, moura mr, melissano g, colombo a, rosanio s. Pdf extravascular stent management for migration of left. The nutcracker syndrome ncs is a described as a mesoaortic compression of the left renal vein between the abdominal aorta and the superior mesenteric artery together with hematuria. A metaanalysis of case series nassir rostambeigi, david hunter.
Jul 24, 2015 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 endovascular therapy of the nutcracker syndrome ncs. Nutcracker phenomenon, renal vein entrapment syndrome, mesoaortic compression of the left renal vein. The patient agreed to undergo another attempt at endovascular therapy. Through nine outstanding editions, rutherfords vascular surgery and endovascular therapy has been the gold standard text in this fastchanging, complex field.
Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or. Stent placement versus angioplasty for hepatic artery. Josephs hospital, buckhannon jefferson medical center, ranson potomac valley hospital, keyser find a doctor luke marone, md. We report a case of migration of a laparoscopically. 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. Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. A novel endovascular treatment of a widenecked basilar apex. Endovascular stent article about endovascular stent by the.
Best of all, the flexive design offers rounded corners and edges and an ultrasmooth surface together with the. Poststent primary and secondary patency rates were determined using kaplanmeier analysis. It was described for the first time in 1996 by nesteet al. Venous compression treatment adelaide, sa may thurner. Under general anesthesia, 3d rotational angiography was performed, confirming an 8mm widenecked basilar apex. The underlying anatomic anomaly, first described by gant in 1937, can lead to left renal venous. The patient was diagnosed with nutcracker syndrome and underwent endovascular stent placement. Li h1, sun x, liu g, zhang y, chu j, deng c, zhou b, chen w, yang j. Common treatments for nutcracker syndrome include stenting, surgery, and routine urine tests. Sep 12, 2006 to update our experience with thoracic aortic stentgraft treatment over a 5year period, with special consideration for the occurrence and management of complications. Ruby memorial hospital, morgantown wvu medicine childrens, morgantown united hospital center, bridgeport camden clark medical center, parkersburg berkeley medical center, martinsburg reynolds memorial hospital, glen dale st. Endovascular stent article about endovascular stent by. Home use of impulse compression of the foot and compression stockings in the.
Given the technical difficulties related to surgically accessing the extracranial vertebral artery, endovascular therapies have been investigated for extracranial vertebral artery disease. Resistant or recurrent stenosis can be successfully treated by endovascular stent placement with durable longterm patency, although multiple procedures are often required. Flaired 6 mm x 50 mm flair endovascular stent graft. Results of endovascular treatment for patients with. Stent placement for upper arm lesions and in arteriovenous access less than 12 months of age was associated with increased risk of patency loss. Discussion endovascular stenting has been used for seventeen years for the treatment of ncs due to its minimally invasive nature. If stent or flowdiversion device placement is planned, pretreatment with antiplatelet therapy may be indicated. Extravascular stent management for migration of left renal. Nutcracker syndrome servier phlebolymphologyservier. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome.
540 545 986 28 612 1502 1582 742 823 156 617 153 1300 254 263 1078 691 49 49 218 989 403 89 361 1461 1039 1107 1076 1540 167 916 209 158 773 950 1609 506 596 1183 1496 877 1393 351 367 897 1272