V03-03: Robotic Extravascular Graft Placement for Nutcracker Syndrome
Our objective is to present a case of Nutcracker Syndrome and our experience with robotic extravascular graft placement. Nutcracker Syndrome is a rare vascular compression condition where the superior mesenteric artery (SMA) compresses the left renal vein against the aorta. It is most common in young, thin, females. It can cause left flank pain, renal vein thrombosis, left renal hypertension, pelvic congestion symptoms, and hematuria. It can be difficult to diagnose and treatment options are not standardized. The use of extravascular grafting was first published in 1988 in vascular surgery literature, but not commonly used when compared to endovascular stenting. However, endovascular stenting, vascular transposition, or autotransplantation, all require invasive vascular work, anticoagulation, and the morbidity associated with these techniques.
This is a case presentation of a young woman who we performed a robotic placement of extravascular graft in an attempt to reduce the compression on the renal vein and alleviate her symptoms. We used the da Vinci Si system and placed a 2cm diameter Gortex Prograft cut to 1.6cm around the left renal vein.
There were no intraoperative complications. The estimated blood loss was 20mL. The patient was discharged on the second post operative day. She did not feel ready to leave the hospital on the first post operative day. One month after surgery, she was feeling well without pain and the hematuria had resolved.
Robotic placement of an extravascular graft for the treatment of Nutcracker Syndrome can be a safe and minimally invasive option for this rare condition.