THE ROLE OF AORTIC-MESENTERIC CLAMP OR THE NUTCRACKER SYNDROME IN THE DEVELOPMENT OF VARICOCELE AND OTHER UROLOGICAL DISEASES

Background. The aorto-mesenteric clamp (AMC), also known as Nutcracker syndrome, is a vascular pathology involving the compression of the left renal vein between the superior mesenteric artery and the aorta. This condition has traditionally been considered rare and challenging to diagnose, often leading to its late detection. The clinical significance of AMC lies in its potential to cause a range of serious complications, including hematuria, proteinuria, pain syndrome, and is a key etiological factor for varicocele in men. While the diagnosis of this syndrome was historically difficult, modern medicine offers a wider arsenal of diagnostic tools. Main Content. Historically, retrograde renal venography has been and in many centers continues to be the diagnostic “gold standard”. This invasive method allows for direct measurement of the pressure gradient between the left renal vein and the inferior vena cava, which is a key diagnostic criterion. However, with advancements in medical imaging, highly informative and less invasive alternatives have emerged. Today, the diagnosis of AMC is increasingly established using radiological methods such as: Doppler ultrasonography, which assesses blood flow velocity at the compression site and serves as an excellent method for primary screening. Contrast-enhanced computed tomography (CT), providing detailed three-dimensional images that visualize the anatomical relationships between the vessels and allow for precise imaging and measurement of the degree of vascular narrowing. Magnetic resonance imaging (MRI), a technique with accuracy comparable to CT but without ionizing radiation, which is particularly important for young patients and when multiple follow-up studies are required. Accurate diagnosis determines treatment strategies, ranging from conservative management to surgical interventions. At the initial stage, for minimally expressed manifestations or an incidental finding, dynamic observation is recommended. Therapy may include weight correction (to increase the angle between the aorta and the superior mesenteric artery), symptomatic treatment for pain management, and blood pressure control. Operative treatment is indicated for persistent pain syndrome, significant hematuria leading to anemia, or progressive varicocele. Traditional open surgical procedures (e.g., nephropexy, venous bypass) were previously standard. In recent years, endovascular stenting has become widely adopted — a minimally invasive procedure where a special stent is placed in the narrowed segment of the vein to restore normal blood flow. This method is gaining popularity worldwide due to shorter hospitalization periods, minimal trauma, and a significantly lower risk of intra- and postoperative complications compared to open surgeries. Conclusions. Thus, aorto-mesenteric clamp is an underdiagnosed yet clinically significant condition. Modern diagnostics have moved beyond invasive venography and now actively employ accurate and safe methods such as CT, MRI, and Doppler ultrasound, enabling timely and correct diagnosis. Treatment tactics have become more flexible and personalized: from conservative observation in mild cases to high-tech minimally invasive interventions in complex ones. Endovascular stenting has confirmed its status as an effective and safe treatment method, offering patients an alternative with fewer risks and rapid recovery. Increasing physician awareness of this pathology and modern management algorithms is key to the successful treatment of patients.