Transazygous hemodialysis access in nutcracker syndrome

Nutcracker syndrome is an uncommon entity, caused by compression of the left renal vein between the superior mesenteric artery and the aorta. Subsequently, increase in venous pressure may cause enlargement and reversal of blood flow in the left gonadal and ureteral veins. In addition, the retroperitoneal collateral venous network of the lumbar and azygous systems, may provide alternate pathways of flow. Here we present a case of transazygous tunneled hemodialysis catheter placement, via the retroperitoneal collateral pathways of compensated nutcracker syndrome. The technique of catheter placement and outcome is discussed.