A simplified surgical approach for left ovarian vein transposition for the treatment of pelvic venous disease from nutcracker syndrome

Nutcracker syndrome is becoming increasingly recognized as a cause of chronic pelvic pain. Several treatment options have been used, including renal vein or ovarian vein transposition to the more distal inferior vena cava and renal vein stenting. Concerned about the major scope of the surgical procedures as well as the implantation of a foreign body that must function for six to seven decades, we undertook to develop an all autogenous simpler surgical solution for the treatment of nutcracker syndrome. In 2013, we began performing left ovarian vein transposition to the left iliac vein. In our initial report, we used a minimally invasive robotic approach. For the past several years, we have used a simplified open approach to left ovarian vein transposition that takes advantage of the fact that the left ovarian vein naturally courses over the iliac vein. We have found this surgical treatment of nutcracker syndrome provides excellent relief from the associated symptoms.