Does High-quality Intervention for Varicose Veins Reduce Progression Towards Complications in the Long Term?

Objectives: Nutcracker syndrome (NCS) is a vascular compression syndrome resulting in left flank pain, abdominal pain, and possibly hematuria, which occurs when the left renal vein is compressed typically between the aorta and the superior mesenteric artery.This can occur with rapid weight loss, resulting in a narrowed aortomesenteric angle.The association with bariatric surgery and left renal vein compression is poorly understood, and the development of NCS after weight loss surgery is not well-represented in the literature.Herein, we present a series of patients who developed NCS following bariatric surgery.Methods: A single-center, retrospective chart review evaluating development of NCS after bariatric surgery between April 2020 and March 2023.Results: We identified six patients who underwent bariatric surgery and subsequently developed symptomatic left renal vein compression necessitating surgery.100% of patients were female, and age ranged from 32 to 68 years old.Gastric bypass accounted for 50% of bariatric procedures, and gastric sleeve was performed in 33% of patients.All patients suffered from left flank pain, and 33% developed hematuria.A dilated left ovarian vein was present in 66% of patients, and dilated lumbar vein was present in 50% of patients.All patients underwent a venous decompression surgery, either left renal vein transposition (33%), left renal artery denervation and left renal vein decompression surgery (50%), or left renal autotransplant (17%).All patients had continued resolution of NCS symptoms at minimum 1 year follow-up.Conclusions: Bariatric surgery and rapid weight loss can lead to a narrowed aortomesenteric angle, loss of visceral fat pad, and compression of the left renal vein.Left-sided abdominal or flank pain or hematuria after bariatric surgery and weight loss may be a sign of developing NCS and should be evaluated.Patients who undergo surgery for NCS after bariatric surgery have excellent symptom relief at follow-up.