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

Introduction: Left renal vein stenting (LRVS) for the treatment of anterior nutcracker syndrome (NCS) has been associated with a significant risk of stent migration into the inferior vena cava or right ventricle. Surgical technique: A hybrid technique is reported for the treatment of NCS to prevent stent migration. The first part of the procedure consists of LRVS at the level of the aortomesenteric compression. The second part consists of laparoscopic stent exofixation through a transperitoneal direct approach. The left renal vein is exposed in order to visualise the stent meshes through the venous wall. Stent exofixation in performed with a simple transfixing polypropylene stitch, reinforced with a Teflon pledget. Discussion: The hybrid treatment of anterior NCS combining laparoscopic stent exofixation with 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. (C) 2021 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.