Hybrid Management for Anterior Nutcracker Syndrome: Left Renal Vein Stenting with Laparoscopic Stent Exofixation

Abstract Introduction Left renal vein stenting (LRVS) for the treatment of anterior nutcracker syndrome (NCS) have been associated with a significant risk of stent migration in the inferior vena cava or the right ventricle. Surgical technique A hybrid technique is reported for the treatment of NCS to prevent the risk of stent migration. The first part of the procedure consists in the LRVS at the level of the aorto-mesenteric compression. The second part consists in the laparoscopic stent exofixation through a transperitoneal direct approach. The left renal vein is exposed in order to visualize the stent meshes through the venous wall. The stent exofixation in performed with a simple transfixing polypropylene stitch, reinforced with a Teflon pledget. Discussion The hybrid treatment of anterior NCS associating laparoscopic stent exofixation to the left renal vein stenting is a simple and low-morbidity technique. Further follow up data are needed to evaluate its potential benefit in reducing the risk of left renal vein stent migration.