Left ovarian to left external iliac vein transposition for the treatment of nutcracker syndrome

Nutcracker syndrome represents the constellation of symptoms caused by extrinsic compression of the left renal vein between the aorta and superior mesenteric artery, producing left renal venous outflow obstruction and, frequently, pelvic venous congestion. When severe, the syndrome is most commonly treated by surgical transposition of the left renal vein onto the inferior vena cava or by renal venous stent placement. Each of these treatment modalities is associated with significant immediate and long-term risks. This report provides the details of a simpler technique for the treatment of nutcracker syndrome by transposing the distal left ovarian to the left external iliac vein. (J Vase Surg: Venous and Lym Dis 2016;4:114-8.)