Case Report Jpn. J. Vasc. Surg., 10:503-507, 2001 
Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome) treated
with Left Renal Vein Transposition
Ikuo Sugimoto,1 Takashi Ohta,1 Hiroyuki Ishibashi,1 Noriyuki Takeuchi,1 Yoshihisa Nagata,1 and Yasuaki Honda2
Second Department of Surgery1 and Department of Urology2, Aichi Medical University

Left renal vein (LRV) entrapment syndrome refers to the compression of the LRV between the aorta and the superior mesenteric artery. This anatomical condition results in renal venous hypertension and renal hilar varices. We report a successful LRV transposition in a case of LRV entrapment syndrome.
A 24-year-old, thin, male baker presented with severe left flank pain and a 9-year history of macroscopic hematuria. Duplex scanning revealed a narrow segment of LRV between the aorta and superior mesenteric artery. Venous velocity in the narrow segment was 160 cm/sec. Computed tomography showed a dilated LRV with abrupt narrowing between the aorta and superior mesenteric artery. Venous pressure in the distal LRV was 14 cm H2O and 7 cm H2O in the vena cava inferior, giving a resulting 7 cm H2O pressure gradient.
Transposition of the left renal vein, 3 cm caudally from the site of origin and was performed. The postoperative course was uneventful, to date the patient has had no macroscopic hematuria after surgery

Key words:
Left renal vein entrapment syndrome, Nutcracker syndrome, Left renal vein, Idiopathic hematuria, Left renal vein transposition