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Nutcracker Syndrome



Nutcracker Syndrome


 What is Nutcracker Syndrome?

Nutcracker syndrome occurs when the vein that empties the left kidney is caught and compressed between the aorta (the main artery of the body in the abdomen) and the superior mesenteric artery which gives blood to the small intestines.

The compression blocks the normal flow of blood in the vein draining the kidney and results in increased pressure within the vein. The increased pressure is transmitted to the kidney itself causing the small capillaries to rupture and bleeding to occur within the kidney tubules Compression of the left renal vein may also cause blood to flow backward into other nearby veins and make them swell, particularly the veins draining the ovaries in females and testicles in males. Nutcracker syndrome gets its name because this compression is like a nutcracker crushing a nut.


At South Charlotte General and Vascular Surgery, our vascular surgeons are recognized experts in the diagnosis and treatment of this condition. They are often able to treat this condition with a safe procedure in our state of the art in-office angiography suite, allowing you to return to work quickly with minimal side effects.



What are some of the symptoms of this syndrome?

Nutcracker syndrome and the increased pressure can cause many symptoms in both children and adults. Most people with nutcracker syndrome have abdominal pain but this condition may be present — especially in children — without any symptoms. Nutcracker syndrome is not hereditary, though it may be triggered by multiple pregnancies.

Other symptoms may include one or more of the following:


  • Blood in the urine or hematuria
  • Pain on your left side (Flank pain)
  • Enlarged varicose veins in the testicles of males
  • Chronic pelvic pain in females
  • Increased protein in the urine (proteinuria)
  • Low blood count (anemia)
  • Pain during intercourse
  • Varicose veins in the upper inner thighs or buttock areas
  • Enlarged veins in testicles (see: varicocele)
  • Lightheadedness while standing, but not while sitting


How common is this syndrome?

It is a rare syndrome and it is unknown how prevalent it is.

It is more common in patients in their 20s and 30s who are tall and slim. Symptoms may appear after rapid weight loss.



How is Nutcracker Syndrome diagnosed?

Abdominal and Pelvic Ultrasound: may be a very useful test but requires special technique to be able to identify the various locations where the veins may be compressed. Our accredited technologists are well versed and specially trained to evaluate pelvic vein compression accurately and precisely.


CT scan or MRI of the pelvis: when done in experienced imaging centers with dye and special filming techniques, both tests can provide a very accurate diagnosis and help our vascular specialists to plan intervention if needed.


Venography: the most definitive test is a direct visualization of the point of compression with intravascular ultrasound which allows them to identify and calculate the degree of the compression.


How is it treated?

The treatment of Nutcracker Syndrome can now be safely done in our accredited angiographic suite in our office, right here in South Charlotte. Different treatments may be recommended to relieve the compression and resolve your symptoms depending on the cause and degree of the compression as well as the status of the nearby veins.

The treatment options include:


Continued monitoring if you have no or minimal symptoms

  • Open surgical repair in patients with severe compression or if the compression returns after stenting.

At South Charlotte General and Vascular Surgery, we are committed to provide you with the best care and best outcomes possible. Our vascular specialists are experts in treating nutcracker syndrome using the latest techniques. We take a team approach to diagnose your condition and design a treatment plan that’s right for you.


If you experience any of the above symptoms or think you may have a vein compression syndrome, please call us to or make an appointment online.


South Charlotte General and Vascular Surgery
13430 Hoover Creek Blvd
Charlotte, NC 28273
Phone: 704-459-3028
Fax: 704-710-8045

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