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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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/9/1461 |
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| author | Mihai-Claudiu Ober Florin-Leontin Lazăr Alexandru Achim Dacian Călin Tirinescu Gregor Leibundgut Călin Homorodean Maria Olinic Horea Laurențiu Onea Mihail Spînu Dan Tătaru Bogdan Săbiescu Dan-Mircea Olinic |
| author_facet | Mihai-Claudiu Ober Florin-Leontin Lazăr Alexandru Achim Dacian Călin Tirinescu Gregor Leibundgut Călin Homorodean Maria Olinic Horea Laurențiu Onea Mihail Spînu Dan Tătaru Bogdan Săbiescu Dan-Mircea Olinic |
| author_sort | Mihai-Claudiu Ober |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-09T23:28:15Z |
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| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T23:28:15Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-6673f174dc364b2e9ef3927d79e9df822023-11-23T17:13:36ZengMDPI AGJournal of Personalized Medicine2075-44262022-09-01129146110.3390/jpm12091461Interventional Management of a Rare Combination of Nutcracker and Wilkie SyndromesMihai-Claudiu Ober0Florin-Leontin Lazăr1Alexandru Achim2Dacian Călin Tirinescu3Gregor Leibundgut4Călin Homorodean5Maria Olinic6Horea Laurențiu Onea7Mihail Spînu8Dan Tătaru9Bogdan Săbiescu10Dan-Mircea Olinic11Department of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaNephrology Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, County Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, RomaniaKlinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, 4410 Liestal, SwitzerlandDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaDepartment of Interventional Cardiology, Medical 1 Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, RomaniaNutcracker 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.https://www.mdpi.com/2075-4426/12/9/1461nutcrackerWilkieendovascular treatmentleft renal vein compressionduodenal compressionmesoaortic angle |
| spellingShingle | Mihai-Claudiu Ober Florin-Leontin Lazăr Alexandru Achim Dacian Călin Tirinescu Gregor Leibundgut Călin Homorodean Maria Olinic Horea Laurențiu Onea Mihail Spînu Dan Tătaru Bogdan Săbiescu Dan-Mircea Olinic Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes Journal of Personalized Medicine nutcracker Wilkie endovascular treatment left renal vein compression duodenal compression mesoaortic angle |
| 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 | nutcracker Wilkie endovascular treatment left renal vein compression duodenal compression mesoaortic angle |
| url | https://www.mdpi.com/2075-4426/12/9/1461 |
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