Raising Awareness for Nutcracker Syndrome and Venous Compression Syndromes

In 2017, Doherty, Newsletter, Volume 9 Issue 3 by Addison Clark

Nutcracker Syndrome is a rare condition, but its rarity doesn’t make it any less painful or difficult to deal with. The syndrome involves the compression or narrowing of the renal vein, which causes the slowing of blood flow from the left kidney. This then presents as abdominal pain and discomfort, or groin pain and pelvic pain. The symptoms are part of what makes Nutcracker Syndrome so hard to diagnose, as abdominal pain is also a symptom of numerous other medical concerns.

According to Dr. Donald Doherty, the Medical Director of Virginia Interventional and Vascular Associates (VIVA), a typical patient is a woman in her twenties to fifties who has had chronic abdominal discomfort. “Sometimes a patient will suffer for one to three years before they typically visit our office,” said Dr. Doherty.

A typical patient could see a variety of doctors, like a gynecologist, a gastroenterologist, or even a surgeon, and still not detect the real problem. Many of these women have undergone invasive medical procedures such as endoscopies or laparoscopies to investigate their chronic pain. This is where medical imaging can make all the difference.

“In the course of the patient’s workup, most patients will have a CT scan or MRI of the abdomen and pelvis,” said Dr. Doherty. “Often the narrowing of the renal vein is seen during the scan. Many of the women will have dialated varicose veins around their ovaries or deeper in their pelvis.”

Treatment involves venography, or inserting a catheter into the affected veins and taking pictures from inside the veins. Ultrasounds may be used from inside the vein to decide if the treatment is necessary. Once it has been decided that treatment will be helpful, a balloon or vascular stent may be used to open the vein. Any dilated veins in the abdomen or pelvis that may be contributing to the symptoms may be treated at the same time. Most procedures are completed in in just a few hours and nearly all patients are able to return to home the same day.

The diagnosis and treatment are all part of what VIVA offers its patients. The physicians at VIVA are fellowship-trained vascular specialists, and their Interventional Radiologists are all well informed when it comes to Nutcracker Syndrome.

“[Interventional Radiologists are] the physicians uniquely qualified to review the whole medical history, integrate it with the imaging history, and then put a plan together for further evaluation and minimally invasive treatment. There’s no other specialty that offers this combination of skills.”

VIVA’s presence in Fredericksburg, North Stafford and surrounding area serves the community well because VIVA’s interventional radiologists are well versed in Nutcracker Syndrome. They are also educated about the two other similiar syndromes: May-Thurner syndrome–or the compression of the veins from the left leg– and pelvic congestion syndrome, venous reflux within the ovarian veins. “All three are interconnected. The treatments [for the three syndromes] are similar and generally if you see one, you must look for the other two.”

As far as Dr. Doherty is concerned, the best way to combat these venous compressions syndromes is to increase awareness. His goal is to educate both patients and referring clinicians about what nutcracker syndrome and the other venous compression syndromes are, what the symptoms look like, and what can be done.

“These syndromes aren’t well understood or well communicated to patients, and we really work to raise awareness,” Dr. Doherty said. “For many women, the symptoms are so vague that by the time someone thinks about it, she may have suffered for several years before someone recommends a consultation with an Interventional Radioligist. There are many of women who needlessly suffer for long periods of time who could be helped with an evaluation and consideration of treatment.”