Reimplantation of the left renal vein in case of nutcracker syndrome: a 25-year experience of one center

Abstract

The aim was to assess the long-term outcomes of the left renal vein reimplantation in case of nutcracker syndrome. Materials and methods. The study included 56 patients with critical stenosis of the left renal vein who underwent left renal vein reimplantation from May 1999 to August 2023. 10 patients were operated on between 1999 and 2013, that provided an opportunity to study long-term outcomes in the period from 7 to 21 years (a retrospective part). 46 patients underwent the surgery between 2018 and 2023 (a prospective part). Results. According to the long-term outcome analysis of the left renal vein reimplantation conducted in the period from 3 months to 21 years, all the patients reported a gradual regression of clinical symptoms, namely, resolution of pain syndrome, hematuria, proteinuria, erectile dysfunction, dyspeptic phenomena. Ultrasonography detected a statistically significant increase in the left renal vein diameter from 1.90 ± 0.87 mm to 7.50 ± 0.76 mm (p = 0.0123) in the aorto-mesenteric segment after the surgery and a statistically significant decrease in the peak systolic velocity from 187.30 ± 2.95 cm/sec to 38.70 ± 0.76 cm/sec (p = 0.0178) in this area. A statistically significant decrease in the left gonadal vein diameter from 6.60 ± 1.30 to 4.20 ± 0.84 mm (p = 0.0118) after the surgery was noted and a decrease in the left kidney parenchymal thickness from 2.20 ± 0.46 to 1.60 ± 0.54 mm (p = 0.0123) was observed. Conclusions. Reimplantation of the left renal vein has been proven to be an effective treatment for critical stenosis of the left renal vein.