Results of Open Surgery in the Treatment of the Renal Vein Compression

Sergey I. Pryadko, Valery S. Arakelyan

«Bakulev National Medical Research Center of Cardiovascular Surgery» of the Ministry of Health of the Russian Federation., Moscow, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective. Compression of renal veins is a common cause of renovascular hypertension (drug-resistant), hematuria, and associated symptoms of pelvic congestion. We aim to describe our clinical and operative experience with such patients.

Methods. We report 11 cases of patients undergoing successful renal vein plastic surgery and 35 patients after gonadoiliacal bypass for the treatment of renal vein сompression. 7 patients were female, 39 male patients (age 7-42 years) and presented with a mean of 14.7 months of drug-resistant renovascular hypertension, abdominal or left flank pain requiring chronic narcotic analgesia. Initial clinical presentations were associated with either hematuria or proteinuria. Diagnosis was supported in each case by imaging (DS, MSCT and/or MRI angio-mode) demonstrating compression of the renal vein.

Phlebohypertension in the renal vein was confirmed according to phlebography with tonometry (mean pressure in the compromised vein of 15/13 mm Hg).

Results. All patients underwent open surgical repair, which included left renal vein reconsruction or gonadoiliacal bypass (mean hospital length of stay 7.8 days). After mean follow-up of 36 months, all patients report complete resolution of symptoms.

Indication for plastic renal vein is an uncorrectable Nutcracker syndrome with symptomatic arterial hypertension; Indication for the imposition of " discharge " (proximal) gonadoiliacal bypass is a Nutcracker syndrome with pressure gradient between the left renal vein and the external iliac vein over 10 mm Hg.

Conclusions. Open surgical interventions (reconstruction of the renal vein or gonadoiliacal bypass) allows to completely heal phlebohypertension of renal veins and exclude dangers associated with the presence of metal structures in the lumen of the vein