[MSB-31] Treatment of Nutcracker Syndrome: Outcomes with Left Renal Vein Transposition and Stenting

Objective: This study aimed to share our experiences and outcomes with left renal vein (LRV) transposition and endovascular stenting in treating Nutcracker syndrome. Methods: Data of 20 female Nutcracker syndrome patients (mean age: 24 years) who underwent LRV transposition (n=15) or stenting (n=5) between July 2019 and June 2024 were retrospectively reviewed. Primary endpoints were morbidity and mortality. Secondary endpoints included late complications, patency, freedom from reintervention, and resolution of symptoms. Results: There were no major complications or mortality after either procedure. The most common signs and symptoms associated with LRV entrapment were left flank pain (100%, n=20), proteinuria (88%, n=15), and hematuria (47%, n=9). After both procedures, classical symptoms resolved in 89.5% (n=17) of patients for left flank pain, 57.8% (n=11) for proteinuria, and 82.3% (n=15) for hematuria. Four patients required reintervention [three after LRV transposition (two for occlusion and one for stenosis) and one after stenting (occlusion)]. The one-year primary patency rate was 87%, and the primary assisted patency rate was 100%. One-year primary patency rates were 91% for the transposition group and 75% for the stent group. The one-year freedom from reintervention was 83%. Conclusion: Both procedures can be used as primary treatments and have their advantages. This study shows that both methods are safe and effective.