Tratamento endovascular da síndrome do quebra-nozes em adolescente: relato de caso
Endovascular treatment of a teenager with nutcracker syndrome: a case report
Sergio Quilici Belczak; Léa Luz; Luciana Barbosa Paglia; Gabriela Prata Ramos Barbosa; Alex Mendes Leonel Freire; Matheus Amparado Miziara; Paulo Eduardo Baldini Lucena; Douglas Yuji Saito
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Abstract
The nutcracker syndrome is caused by compression of the left renal vein by the superior mesenteric artery and aorta and is associated with characteristic symptoms, such as lower abdominal pain, varicocele, and hematuria. Diagnosis is often difficult and, therefore, is often delayed. Invasive treatment is controversial, particularly in pediatric patients. However, it is indicated in cases of gross hematuria associated with anemia, renal function impairment, severe pelvic pain, or ineffective conservative treatment. We report the case of a 12-year-old boy presenting with severe hematuria for 12 hours, with no abnormal findings at a first evaluation, who progressed with severe anemia and urinary retention. Further investigation provided images suggestive of nutcracker syndrome, and endovascular stenting (smart control stent) followed by balloon dilatation was the treatment of choice. Hematuria ceased after the procedure, and the patient is still asymptomatic at 5-year follow-up.
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1 Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85(6):552-9.
2 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.
3 Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y. A systematic review on management of nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2018;6(2):271-8.
4 Silva M, Maurano A, Mendes G, et al. Síndrome de nutcracker: a aplicação da ultrassonografia com Doppler e relato de caso. Rev Imagem. 2007;29(3):121-4.
5 Dever DP, Ginsburg ME, Millet DJ, Feinstein MJ, Cockett AT. Nutcracker phenomenon. Urology. 1986;27(6):540-2.
6 Almeida R, Barros E, Balbinotto A, Thomé FS, da Costa FP. Síndrome de Nutcracker: relato de caso. Rev Bras Clin Med. 2010;8(3):283-5.
7 Sousa B, Tavares M, Braga A, et al. Síndrome Nutcracker como causa de hematúria recorrente. Acta Pediam Port. 2002;6(33):441-4.
8 Neupane S, Ambulgekar N, Edla S, Torey J, Gottam N, Yamasaki H. Intravascular ultrasound-guided endovascular stenting of renal vein in nutcracker syndrome. Vasc Endovascular Surg. 2018;52(5):355-6.
9 Chen W, Chu J, Yang JY, et al. Endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients. J Vasc Interv Radiol. 2005;16(11):1529-33.
10 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.
11 Sebastian T, Erdoes G, Bratu VA, Baumgartner I, Kucher N. Endovascular extraction of a migrated large self-expanding laser-cut renal venous stent from the right ventricle. J Vasc Surg Cases Innov Tech. 2017;3(2):79-82.
12 Rodríguez-Morata A, Robles-Martín ML, Reyes-Ortega JP. Endovascular treatment of posterior nutcracker syndrome with a new autoexpandable stent. J Vasc Surg Venous Lymphat Disord. 2019;7(1):118-21.