Renal Venous Hypertension Decompression in Nutcracker Syndrome Using an Original Reno-Hemiazygo-Lumbo-Caval Anastomosis

This article presents a successful case of treating a patient with nutcracker syndrome (compression of the left renal vein) who had previously undergone unsuccessful treatment for neurogenic bladder dysfunction presenting with dysuria, proteinuria, and episodes of macro- and microhematuria. The authors propose an original concept regarding the pathophysiological mechanisms of venous hypertension in the left renal vein distribution. The underlying concept is based on the presence of a reflux-dependent vein serving as a pathway for retrograde or collateral blood outflow, which leads to partial spontaneous decompression of the left renal vein system. Based on this concept, a surgical decompression approach was developed involving the use of reflux-dependent vein to create a shunt via an anastomosis with the inferior vena cava, which offers the lowest vascular resistance. In the described case, hemiazygos-lumbar trunk (HALT), through which pathological blood shunting via the hemiazygos vein occured, served as the patient’s reflux-dependent vessel. The original Reno-HAL-CA (Reno-hemiazygo-lumbo-caval Anastomosis) operation, i.e. the use of HALT in the form of an autovenous shunt with an end-to-side anastomosis with the inferior vena cava, completely eliminated left-sided venous renal hypertension and the patient’s complaints.