A novel hybrid left renal vein transposition and endovascular stenting technique for the treatment of posterior nutcracker syndrome

Posterior nutcracker syndrome occurs when a retroaortic left renal vein becomes compressed between the abdominal aorta and the lumbar spine. Although open surgical approaches remain the treatment of choice, endovascular stenting has been used successfully. We describe a case of a 28-year-old man who presented with microscopic hematuria, left-sided flank pain, and testicular swelling. Computed tomography findings were consistent with posterior nutcracker syndrome. He underwent a novel hybrid operation that included left renal vein transposition followed by endovascular stenting. Repeated imaging at 3 and 12 months revealed a patent stent with complete resolution of symptoms.