Nutcracker syndrome treated by intravascular ultrasound-guided endovascular stenting

Nutcracker syndrome is an uncommon disease and should be easily overlooked. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery. Hematuria and abdominal or flank pain are the most common symptoms. We present a 36-year-old female with chronic lower abdominal pain for 2 months. Computed tomography revealed extrinsic compression of the left renal vein by the aorta and superior mesenteric artery. Venography with pressure measurement showed a 6-mmHg pressure gradient between the left renal vein and the inferior vena cava. Nutcracker syndrome was confirmed. Endovascular stenting was performed under intravascular ultrasound guidance. After procedure, the pressure gradient between the left renal vein and inferior vena cava fell to 0-mmHg and her symptoms resolved. Endovascular stenting is becoming popular among intervention therapies as it is less invasive with a satisfactory result. Intravascular ultrasound can provide more precise lesion information and is helpful in stent sizing and identifying appropriate landing zone.