Laparoscopic approach for treatment of left renal vein pathologies: symptomatic nutcracker syndrome and arteriovenosus fistula – single center experience.
EAES Academy. Jęckowski M. 07/05/22; 363122; P167
Dr. Mateusz Jęckowski
Contributions
Contributions
Abstract
Left renal veins pathologies are rare disorders with difficulties in diagnosis and limited treatment options. In our department two of it has been treated by laparoscopy.
Symptomatic nutcracker syndrome (NCS) is caused by compression of left renal vein. This pathology is classified into two types: first is caused by narrow angle between the superior mesenteric artery and aorta, the second is anatomical variant, when renal vein is localised between aorta and spinal column. NCS is diagnosed mainly as exclusion diagnosis in patients presenting symptoms as left flank pain, hematuria or vaginismus. Treatment experience in this field is collected mainly through open surgery techniques, in which open left renal vein transposition is considered to be the gold standard technique. However, we present our experience with laparoscopic treatment of 3 female Caucasian patients with symptomatic NCS. One patient suffered from left flank pain and two others from pelvic congestions syndrome (PCS).
Iatrogenic arteriovenosus fistulas of left renal vessels is a rare complication - just 68 cases have been described since the first raport in 1934. Cardiac failure or pseudoaneurysm is a frequent and serious sequel, therefore closure of the fistula is indicated. Endovascular or open approach are the most frequent therapeutic options. Fifty-nine year old Caucasian female with history of left nephrectomy due to pyonephrosis twenty-one years ago has been diagnosed with arteriovenosus fistula with pseudoaneurysm. In our department after endovascular treatment failure we decided to consider laparoscopy as another option.
Treatment in all cases has been performed without any intraoperative complications. Hospitalization went uneventfully with median stay of 5 days. Follow-up effect of treatment is good. In PCS patients complete resolution of symptoms followed by laparoscopic intervention was observed. Among other case reports, the data of laparoscopic treatment of NCS and arteriovenosus fistulas is very limited, but due to favorable length of hospitalization and less invasiveness it appears to be safe and effective method, although further research should be conducted.
Symptomatic nutcracker syndrome (NCS) is caused by compression of left renal vein. This pathology is classified into two types: first is caused by narrow angle between the superior mesenteric artery and aorta, the second is anatomical variant, when renal vein is localised between aorta and spinal column. NCS is diagnosed mainly as exclusion diagnosis in patients presenting symptoms as left flank pain, hematuria or vaginismus. Treatment experience in this field is collected mainly through open surgery techniques, in which open left renal vein transposition is considered to be the gold standard technique. However, we present our experience with laparoscopic treatment of 3 female Caucasian patients with symptomatic NCS. One patient suffered from left flank pain and two others from pelvic congestions syndrome (PCS).
Iatrogenic arteriovenosus fistulas of left renal vessels is a rare complication - just 68 cases have been described since the first raport in 1934. Cardiac failure or pseudoaneurysm is a frequent and serious sequel, therefore closure of the fistula is indicated. Endovascular or open approach are the most frequent therapeutic options. Fifty-nine year old Caucasian female with history of left nephrectomy due to pyonephrosis twenty-one years ago has been diagnosed with arteriovenosus fistula with pseudoaneurysm. In our department after endovascular treatment failure we decided to consider laparoscopy as another option.
Treatment in all cases has been performed without any intraoperative complications. Hospitalization went uneventfully with median stay of 5 days. Follow-up effect of treatment is good. In PCS patients complete resolution of symptoms followed by laparoscopic intervention was observed. Among other case reports, the data of laparoscopic treatment of NCS and arteriovenosus fistulas is very limited, but due to favorable length of hospitalization and less invasiveness it appears to be safe and effective method, although further research should be conducted.
Left renal veins pathologies are rare disorders with difficulties in diagnosis and limited treatment options. In our department two of it has been treated by laparoscopy.
Symptomatic nutcracker syndrome (NCS) is caused by compression of left renal vein. This pathology is classified into two types: first is caused by narrow angle between the superior mesenteric artery and aorta, the second is anatomical variant, when renal vein is localised between aorta and spinal column. NCS is diagnosed mainly as exclusion diagnosis in patients presenting symptoms as left flank pain, hematuria or vaginismus. Treatment experience in this field is collected mainly through open surgery techniques, in which open left renal vein transposition is considered to be the gold standard technique. However, we present our experience with laparoscopic treatment of 3 female Caucasian patients with symptomatic NCS. One patient suffered from left flank pain and two others from pelvic congestions syndrome (PCS).
Iatrogenic arteriovenosus fistulas of left renal vessels is a rare complication - just 68 cases have been described since the first raport in 1934. Cardiac failure or pseudoaneurysm is a frequent and serious sequel, therefore closure of the fistula is indicated. Endovascular or open approach are the most frequent therapeutic options. Fifty-nine year old Caucasian female with history of left nephrectomy due to pyonephrosis twenty-one years ago has been diagnosed with arteriovenosus fistula with pseudoaneurysm. In our department after endovascular treatment failure we decided to consider laparoscopy as another option.
Treatment in all cases has been performed without any intraoperative complications. Hospitalization went uneventfully with median stay of 5 days. Follow-up effect of treatment is good. In PCS patients complete resolution of symptoms followed by laparoscopic intervention was observed. Among other case reports, the data of laparoscopic treatment of NCS and arteriovenosus fistulas is very limited, but due to favorable length of hospitalization and less invasiveness it appears to be safe and effective method, although further research should be conducted.
Symptomatic nutcracker syndrome (NCS) is caused by compression of left renal vein. This pathology is classified into two types: first is caused by narrow angle between the superior mesenteric artery and aorta, the second is anatomical variant, when renal vein is localised between aorta and spinal column. NCS is diagnosed mainly as exclusion diagnosis in patients presenting symptoms as left flank pain, hematuria or vaginismus. Treatment experience in this field is collected mainly through open surgery techniques, in which open left renal vein transposition is considered to be the gold standard technique. However, we present our experience with laparoscopic treatment of 3 female Caucasian patients with symptomatic NCS. One patient suffered from left flank pain and two others from pelvic congestions syndrome (PCS).
Iatrogenic arteriovenosus fistulas of left renal vessels is a rare complication - just 68 cases have been described since the first raport in 1934. Cardiac failure or pseudoaneurysm is a frequent and serious sequel, therefore closure of the fistula is indicated. Endovascular or open approach are the most frequent therapeutic options. Fifty-nine year old Caucasian female with history of left nephrectomy due to pyonephrosis twenty-one years ago has been diagnosed with arteriovenosus fistula with pseudoaneurysm. In our department after endovascular treatment failure we decided to consider laparoscopy as another option.
Treatment in all cases has been performed without any intraoperative complications. Hospitalization went uneventfully with median stay of 5 days. Follow-up effect of treatment is good. In PCS patients complete resolution of symptoms followed by laparoscopic intervention was observed. Among other case reports, the data of laparoscopic treatment of NCS and arteriovenosus fistulas is very limited, but due to favorable length of hospitalization and less invasiveness it appears to be safe and effective method, although further research should be conducted.
{{ help_message }}
{{filter}}