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Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes

Nutcracker and Wilkie syndromes are rare mesoaortic compression entities, and their association is even less common. Data on interventional treatment of these pathologies are still scarce, but results from limited case series are encouraging. We report the case of a previously healthy 45-year-old wo...

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Autores principales: Ober, Mihai-Claudiu, Lazăr, Florin-Leontin, Achim, Alexandru, Tirinescu, Dacian Călin, Leibundgut, Gregor, Homorodean, Călin, Olinic, Maria, Onea, Horea Laurențiu, Spînu, Mihail, Tătaru, Dan, Săbiescu, Bogdan, Olinic, Dan-Mircea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503687/
https://www.ncbi.nlm.nih.gov/pubmed/36143249
http://dx.doi.org/10.3390/jpm12091461
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author Ober, Mihai-Claudiu
Lazăr, Florin-Leontin
Achim, Alexandru
Tirinescu, Dacian Călin
Leibundgut, Gregor
Homorodean, Călin
Olinic, Maria
Onea, Horea Laurențiu
Spînu, Mihail
Tătaru, Dan
Săbiescu, Bogdan
Olinic, Dan-Mircea
author_facet Ober, Mihai-Claudiu
Lazăr, Florin-Leontin
Achim, Alexandru
Tirinescu, Dacian Călin
Leibundgut, Gregor
Homorodean, Călin
Olinic, Maria
Onea, Horea Laurențiu
Spînu, Mihail
Tătaru, Dan
Săbiescu, Bogdan
Olinic, Dan-Mircea
author_sort Ober, Mihai-Claudiu
collection PubMed
description Nutcracker and Wilkie syndromes are rare mesoaortic compression entities, and their association is even less common. Data on interventional treatment of these pathologies are still scarce, but results from limited case series are encouraging. We report the case of a previously healthy 45-year-old woman diagnosed with nutcracker and Wilkie syndromes who presented with macroscopic hematuria, intermittent pain in the left flank and hypogastric region, postprandial nausea, and unexplained significant weight loss. A successful endovascular approach with stent implantation in the left renal vein was performed, but the stent migrated toward the left kidney, and this acute complication was managed through an interventional strategy as well. At the three-month follow-up, the patient described a marked improvement in all symptoms, except for the macroscopic hematuria. As it was our strong belief that the approach was efficient, we further investigated the “hematuria”, which eventually led to the diagnosis of endometrial carcinoma. A hysterectomy and bilateral adnexectomy were planned, and chemoradiotherapy was initiated with the goal of preoperative tumor reduction. To our knowledge, this is the first reported case in which both Wilkie and nutcracker syndromes were effectively treated by stent implantation in the left renal vein, complicated with very early stent migration due to inadequate apposition to the less compliant venous lumen. The treatment of the duodenal compression was indirectly included in the stenting of the left renal vein, as reclaiming the venous lumen widened the aortomesenteric angle. The aim of this review is to discuss our center’s transcatheter experience with these rare disorders and explore the literature in order to establish the benefits and limitations of such an approach.
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spelling pubmed-95036872022-09-24 Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes Ober, Mihai-Claudiu Lazăr, Florin-Leontin Achim, Alexandru Tirinescu, Dacian Călin Leibundgut, Gregor Homorodean, Călin Olinic, Maria Onea, Horea Laurențiu Spînu, Mihail Tătaru, Dan Săbiescu, Bogdan Olinic, Dan-Mircea J Pers Med Review Nutcracker and Wilkie syndromes are rare mesoaortic compression entities, and their association is even less common. Data on interventional treatment of these pathologies are still scarce, but results from limited case series are encouraging. We report the case of a previously healthy 45-year-old woman diagnosed with nutcracker and Wilkie syndromes who presented with macroscopic hematuria, intermittent pain in the left flank and hypogastric region, postprandial nausea, and unexplained significant weight loss. A successful endovascular approach with stent implantation in the left renal vein was performed, but the stent migrated toward the left kidney, and this acute complication was managed through an interventional strategy as well. At the three-month follow-up, the patient described a marked improvement in all symptoms, except for the macroscopic hematuria. As it was our strong belief that the approach was efficient, we further investigated the “hematuria”, which eventually led to the diagnosis of endometrial carcinoma. A hysterectomy and bilateral adnexectomy were planned, and chemoradiotherapy was initiated with the goal of preoperative tumor reduction. To our knowledge, this is the first reported case in which both Wilkie and nutcracker syndromes were effectively treated by stent implantation in the left renal vein, complicated with very early stent migration due to inadequate apposition to the less compliant venous lumen. The treatment of the duodenal compression was indirectly included in the stenting of the left renal vein, as reclaiming the venous lumen widened the aortomesenteric angle. The aim of this review is to discuss our center’s transcatheter experience with these rare disorders and explore the literature in order to establish the benefits and limitations of such an approach. MDPI 2022-09-06 /pmc/articles/PMC9503687/ /pubmed/36143249 http://dx.doi.org/10.3390/jpm12091461 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ober, Mihai-Claudiu
Lazăr, Florin-Leontin
Achim, Alexandru
Tirinescu, Dacian Călin
Leibundgut, Gregor
Homorodean, Călin
Olinic, Maria
Onea, Horea Laurențiu
Spînu, Mihail
Tătaru, Dan
Săbiescu, Bogdan
Olinic, Dan-Mircea
Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes
title Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes
title_full Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes
title_fullStr Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes
title_full_unstemmed Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes
title_short Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes
title_sort interventional management of a rare combination of nutcracker and wilkie syndromes
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503687/
https://www.ncbi.nlm.nih.gov/pubmed/36143249
http://dx.doi.org/10.3390/jpm12091461
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