Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.012417
Jornal Vascular Brasileiro
Review Article

Diagnóstico e tratamento da síndrome de quebra-nozes (nutcracker): revisão dos últimos 10 anos

Diagnosis and treatment of the Nutcracker syndrome: a review of the last 10 years

Guilherme Lourenço de Macedo, Matheus Alves dos Santos, Andrey Biff Sarris, Ricardo Zanetti Gomes

Downloads: 0
Views: 117

Resumo

A síndrome de quebra-nozes é caracterizada por um grupo de manifestações clínicas que ocorrem por conta da compressão da veia renal esquerda. Seus principais sintomas são macro e micro-hematúria, proteinúria e dor no flanco. O diagnóstico é geralmente realizado após a exclusão de outras causas mais comuns, por conta da ausência de critérios clínicos para diagnóstico. Sua confirmação é feita por exames de imagem, com uso da ultrassonografia Doppler e tomografia computadorizada. O tratamento pode variar com as características do paciente e com a gravidade dos sintomas, e inclui o tratamento conservador, a cirurgia aberta e a cirurgia endovascular. Atualmente, a cirurgia aberta continua sendo a linha de frente, mas abordagens menos invasivas vêm ganhando cada vez mais espaço.

Palavras-chave

síndrome de quebra-nozes; hematúria; nefrectomia; stents.

Abstract

The nutcracker syndrome is characterized by a group of clinical manifestations caused by compression of the Left Renal Vein. The main symptoms are: macro and micro hematuria, proteinuria, and flank pain. Diagnosis is usually made after excluding other causes, because there are no clinical criteria for diagnosis. Confirmation is by Doppler ultrasonography or computed tomography. Treatment can vary, depending on patient characteristics and the severity of the symptoms, while conservative treatment, open surgery, and endovascular surgery may be employed. Currently, open surgery is still the first-line treatment, but some less invasive approaches are gaining acceptance.

Keywords

renal nutcracker syndrome; hematuria; nephrectomy; stents.

References

1. Calado R, Braz M, Lobo L, Simão C. Síndrome de Nutcracker: hematúria sem diagnóstico. Acta Med Port. 2011;24(Suppl 3):695-8. PMid:22856415.

2. Zucker EJ, Ganguli S, Ghoshhajra BB, Gupta R, Prabhakar AM. Imaging of venous compression syndromes. Cardiovasc Diagn Ther. 2016;6(6):519-32. http://dx.doi.org/10.21037/cdt.2016.11.19. PMid:28123973.

3. Avgerinos ED, McEnaney R, Chaer RA. Surgical and endovascular interventions for nutcracker syndrome. Semin Vasc Surg. 2013;26(4):170-7. http://dx.doi.org/10.1053/j.semvascsurg.2014.06.014. PMid:25220323.

4. Novaes LF, Silva Saguia LN, Di Migueli CA, et al. Young woman with nutcracker syndrome without main clinic manifestation: hematuria-case report. Int J Surg Case Rep. 2017;31:225-8. http://dx.doi.org/10.1016/j.ijscr.2017.01.052. PMid:28189985.

5. Daily R, Matteo J, Loper T, Northup M. Nutcracker syndrome: symptoms of syncope and hypotension improved following endovascular stenting. Vascular. 2012;20(6):337-41. http://dx.doi.org/10.1258/vasc.2011.cr0320. PMid:22734085.

6. Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker syndrome. World J Nephrol. 2014;3(4):277-81. http://dx.doi.org/10.5527/wjn.v3.i4.277. PMid:25374822.

7. Ananthan K, Onida S, Davies AH. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Surg. 2017;3(6):886-94. http://dx.doi.org/10.1016/j.ejvs.2017.02.015. PMid:28356209.

8. Kurklinsky AK, Rooke TW. Nutcracker phenomenon and Nutcracker syndrome. Mayo Clin Proc. 2010;85(53):552-9. http://dx.doi.org/10.4065/mcp.2009.0586. PMid:20511485.

9. Venkatachalam S, Bumpus K, Kapadia SR, Gray B, Lyden S, Shishehbor MH. The Nutcracker syndrome. Ann Vasc Surg. 2011;25(8):1154-64. http://dx.doi.org/10.1016/j.avsg.2011.01.002. PMid:21439772.

10. Poyraz AK, Firdolas F, Onur MR, Kocakoc E. Evaluation of left renal vein entrapment using multidetector computed tomography. Acta Radiol. 2013;54(2):144-8. http://dx.doi.org/10.1258/ar.2012.120355. PMid:23117197.

11. Cardarelli-Leite L, Velloni FG, Salvadori PS, Lemos MD, D’Ippolito G. Síndromes vasculares abdominais: achados de imagem característicos. Radiol Bras. 2016;49(4):257-63. http://dx.doi.org/10.1590/0100-3984.2015.0136. PMid:27777480.

12. Kim SH, Cho SW, Kim HD, Chung JW, Park JH, Han MC. Nutcracker syndrome: diagnosis with Doppler US. Radiology. 1996;198(1):93-7. http://dx.doi.org/10.1148/radiology.198.1.8539413. PMid:8539413.

13. Hulsberg PC, Mcloney E, Partovi S, Davidson JC, Patel IJ. Minimally invasive treatments for venous compression syndromes. Cardiovasc Diagn Ther. 2010;6(6):582-92. http://dx.doi.org/10.21037/cdt.2016.10.01. PMid:28123978.

14. Menard MT. Nutcracker syndrome: when should it be treated and how? Perspect Vasc Surg Endovasc Ther. 2009;21(2):117-24. http://dx.doi.org/10.1177/1531003509338402. PMid:19703821.

15. Berthelot JM, Douane F, Maugars Y, Frampas E. Nutcracker syndrome: a rare cause of left flank pain that can also manifest as unexplained pelvic pain. Joint Bone Spine. 2016;84(5):111-6. PMid:27932281.

16. Xu D, Liu Y, Gao Y, et al. Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature. J Med Case Reports. 2009;3(1):82. http://dx.doi.org/10.1186/1752-1947-3-82. PMid:19946558.

17. Said SM, Gloviczki P, Kalra M, et al. Renal Nutcracker syndrome: surgical options. Semin Vasc Surg. 2013;26(1):35-42. http://dx.doi.org/10.1053/j.semvascsurg.2013.04.006. PMid:23932560.

18. He Y, Wu Z, Chen S, et al. Nutcracker syndrome—how well do we know it? Urology. 2014;83(1):12-7. http://dx.doi.org/10.1016/j.urology.2013.08.033. PMid:24139744.

19. Erben Y, Gloviczki P, Kalra M, et al. Treatment of Nutcracker syndrome with open and endovascular interventions. J Vasc Surg Venous Lymphat Disord. 2015;3(4):389-96. http://dx.doi.org/10.1016/j.jvsv.2015.04.003. PMid:26992616.

20. Reed NR, Kalra M, Bower TC, Vrtiska TJ, Ricotta JJ 2nd, Gloviczki P. Left renal vein transposition for Nutcracker syndrome. J Vasc Surg. 2009;49(2):386-93, discussion 393-4. http://dx.doi.org/10.1016/j.jvs.2008.09.051. PMid:19216958.

21. Hmida W, Mallat F, Othmen MB, Limayem F, Mosbah F. Modified medial nephropexy for treatment of the anterior nutcracker syndrome. Urol Ann. 2014;6(4):352-5. http://dx.doi.org/10.4103/0974-7796.141004. PMid:25371615.

22. Wang L, Yi L, Yang L, et al. Diagnosis and surgical treatment of Nutcracker Syndrome: a single-center experience. Urology. 2009;73(4):871-6. http://dx.doi.org/10.1016/j.urology.2008.11.043. PMid:19193424.

23. Thaveau F, Nicolini P, Lucereau B, Georg Y, Lejay A, Chakfe N. Associated Da Vinci and magellan robotic systems for successful treatment of nutcracker syndrome. J Laparoendosc Adv Surg Tech A. 2015;25(1):60-3. http://dx.doi.org/10.1089/lap.2013.0532. PMid:25531954.

24. Skeik N, Gloviczki P, Macedo TA. Posterior Nutcracker Syndrome. Vasc Endovascular Surg. 2011;45(8):749-55. http://dx.doi.org/10.1177/1538574411419376. PMid:21890560.

25. Deser SB, Onem K, Demirag MK, Buyukalpelli R. Surgical treatment of posterior nutcracker syndrome presented with hyperaldosteronism. Interact Cardiovasc Thorac Surg. 2016;22(5):682-4. http://dx.doi.org/10.1093/icvts/ivw018. PMid:26892192.

26. Wang X, Zhang Y, Li C, Zhang H. Results of endovascular treatment for patients with nutcracker syndrome. J Vasc Surg. 2012;56(1):142-8. http://dx.doi.org/10.1016/j.jvs.2012.01.007. PMid:22575480.

27. Quevedo HC, Arain SA, Abi Rafeh N. Systematic review of endovascular therapy for nutcracker syndrome and case presentation. Cardiovasc Revasc Med. 2014;15(5):305-7. http://dx.doi.org/10.1016/j.carrev.2014.04.008. PMid:24907226.

28. Baril DT, Polanco P, Makaroun MS, Chaer RA. Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of Nutcracker syndrome. J Vasc Surg. 2011;53(4):1100-3. http://dx.doi.org/10.1016/j.jvs.2010.10.112. PMid:21215570.

29. Tian L, Chen S, Zhang G, Zhang H, Jin W, Li M. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome. BMC Urol. 2015;15(1):73-6. http://dx.doi.org/10.1186/s12894-015-0063-0. PMid:26205510.

30. Cunha JR Jr, Souza TC, Feitosa AT, Brizzi JR, Tinoco JA. Tratamento endovascular da Síndrome de Quebra-nozes (Nutcracker). J Vasc Bras. 2013;12(3):247-51. http://dx.doi.org/10.1590/jvb.2013.034.

31. Alcocer-Gamba MA, Martínez-Chávez JA, Alcántara-Razo M, et al. Tratamiento endovascular exitoso del síndrome de cascanueces com stent autoexpandible. Arch Cardiol Mex. 2012;82(4):303-7. http://dx.doi.org/10.1016/j.acmx.2012.09.006. PMid:23164741.

32. Chen S, Zhang H, Shi H, Tian L, Jin W, Li M. Endovascular stenting for treatment of Nutcracker syndrome: report of 61 cases with long-term followup. J Urol. 2011;186(2):570-5. http://dx.doi.org/10.1016/j.juro.2011.03.135. PMid:21683388.

33. Hansraj N, Hamdi A, Khalifeh A, Wise E, Sarkar R, Toursavadkohi S. Nutcracker syndrome: case report on the management of recurrent stenosis after stenting. Vasc Endovascular Surg. 2017;51(4):203-8. http://dx.doi.org/10.1177/1538574417700012. PMid:28424043.

34. Wu Z, Zheng X, He Y, et al. Stent migration after endovascular stenting in patients with nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2016;4(2):193-9. http://dx.doi.org/10.1016/j.jvsv.2015.10.005. PMid:26993867.

35. Rana MA, Oderich GS, Bjarnason H. Endovenous removal of dislodged left renal vein stent in a patient with nutcracker syndrome. Semin Vasc Surg. 2013;26(1):43-7. http://dx.doi.org/10.1053/j.semvascsurg.2013.04.004. PMid:23932561.

36. O’Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2015;3(1):96-106. http://dx.doi.org/10.1016/j.jvsv.2014.05.007. PMid:26993690.

37. Ferreira M, Lanziotti L, Abuhadba G, Monteiro M, Capotorto L, Spicacci JL. Dor pélvica crônica: o papel da síndrome do quebranozes. J Vasc Bras. 2008;7(1):76-9. http://dx.doi.org/10.1590/ S1677-54492008000100014.

5cd1989d0e8825e744632f8e jvb Articles

J Vasc Bras

Share this page
Page Sections