What vessels does fibromuscular dysplasia affect?
Most medium sized arteries - e.g. internal carotid and renals
What layer of the vessel does fibromuscular dysphasia affect?
What is the prevalence of fibromuscular dysphasia?
Who gets fibromuscular dysphasia? (Age, sex)
What is the theory for pathogenesis of fibromuscular dysplasia?
Ischemia of vasovasorum. Arteries affected are internal carotid, vertebral and renals that have long segments without branch points thus less vasovasora.
Which renal artery is more affected by fibromuscular dysphasia?
Right more than left. Longer, therefore less vasovasorum/prone to vessel wall ischemia.
What is the definition of nutcracker syndrome?
Compression of left renal vein by SMA. Nutcracker syndrome = constellation of symptoms. NC phenomenon if asymptomatic.
What are risk factors of nutcracker syndrome?
Low BMI, young female
How can low BMI lead to nutcracker syndrome?
Paraspinal muscle wasting and low mesenteric/retroperitoneal fat means that SMA is at a more acute angle <16 degrees vs normal 35-40 degrees
What are the 3 anatomical types of nutcracker syndrome?
Anterior and posterior. Also "atypical" circumaortic renal vein or congenital malformations e.g. left IVC
What is posterior nutcracker syndrome
Usually with retroaortic vein, compression of left renal vein against vertebral body
What are symptoms of nutcracker syndrome?
Hematuria and left flank pain. Also genital varices, pain with menses/sex/urination, protienuria and abdo pain
What is the duplex criteria for nutcracker syndrome?
Flow velocities/diameter proximal and distal to stenosis ratio > 5
What is the most common open operation for nutcracker syndrome?
Renal vein transposition onto the IVC more caudally. Gonadal and adrenal veins often have to be ligated.
What are open options for anterior nutcracker syndrome?
Left renal vein transposition +/- patch or saphenous vein cuff. Gonadal vein transposition. Saphenous vein bypass from LRV to IVC.
What open operations can be used for both anterior and posterior nutcracker syndrome?
Gonadal vein transposition, saphenous vein bypass from LRV to IVC
What is the rate of migration for renal vein stenting?
7%. Can possibly migrate to right atrium and require open heart surgery!