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- W2115379576 abstract "Editor:We read with interest the article by Chen et al (1Chen W Chu J Yang JY et al.Endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients.J Vasc Interv Radiol. 2005; 16: 1529-1533Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar) concerning endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients. Nutcracker syndrome is attributable to idiopathic decrease in the angle between the aorta and the superior mesenteric artery with consequent compression of the left renal vein, and surgical procedures such as Gore-Tex graft vein interposition, nephropexy, and kidney autotransplantation are available to correct the compression of the left renal vein (2Russo D Minutolo R Iaccarino V et al.Gross hematuria of uncommon origin: the nutcracker syndrome.Am J Kidney Dis. 1998; 32: E3Abstract Full Text Full Text PDF PubMed Google Scholar). However, endovascular stent treatment has recently been suggested as a safer and more efficient technique than surgical procedures and may represent a valuable approach to the treatment of adult nutcracker syndrome (3Hartung O Grisoli D Boufi M et al.Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome: lessons learned from the first five cases.J Vasc Surg. 2005; 42: 275-280Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar). Nevertheless, the invasive treatment of childhood nutcracker syndrome is still under debate.Our previous report (4Shin JI Park JM Lee SM et al.Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome.Pediatr Nephrol. 2005; 20: 609-613Crossref PubMed Scopus (91) Google Scholar) demonstrated that aortomesenteric compression could resolve spontaneously within a relatively short time (mean, 1.4 y; range, 0.5–3.5 y) as a result of physical development during childhood. Although a major factor affecting the decrease of the peak flow velocity in the aortomesenteric portion of the left renal vein was the increase in body mass index, the increase in diameters of the left renal vein by growth might also influence the renal hemodynamics.These findings suggest that the first therapy for hematuria of childhood nutcracker syndrome should be observation. However, in our study, some patients showed persistent hematuria despite the decrease of the peak velocity in the aortomesenteric portion of the left renal vein, indicating that these patients might require therapy.Therefore, we believe that endovascular stent placement should be considered when this syndrome leads to persistent clinical symptoms after a sufficiently long period of observation, and should be guided by the clinical, radiologic, and renal hemodynamic findings. We suggest that the period of observation should be at least 2 to 3 years, because 15 of the 20 patients with nutcracker syndrome (75%) showed complete resolution of hematuria within 3 years of follow-up. Further studies and long-term follow-up are necessary before endovascular stent placement is accepted for the treatment of childhood nutcracker syndrome. Editor: We read with interest the article by Chen et al (1Chen W Chu J Yang JY et al.Endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients.J Vasc Interv Radiol. 2005; 16: 1529-1533Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar) concerning endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients. Nutcracker syndrome is attributable to idiopathic decrease in the angle between the aorta and the superior mesenteric artery with consequent compression of the left renal vein, and surgical procedures such as Gore-Tex graft vein interposition, nephropexy, and kidney autotransplantation are available to correct the compression of the left renal vein (2Russo D Minutolo R Iaccarino V et al.Gross hematuria of uncommon origin: the nutcracker syndrome.Am J Kidney Dis. 1998; 32: E3Abstract Full Text Full Text PDF PubMed Google Scholar). However, endovascular stent treatment has recently been suggested as a safer and more efficient technique than surgical procedures and may represent a valuable approach to the treatment of adult nutcracker syndrome (3Hartung O Grisoli D Boufi M et al.Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome: lessons learned from the first five cases.J Vasc Surg. 2005; 42: 275-280Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar). Nevertheless, the invasive treatment of childhood nutcracker syndrome is still under debate. Our previous report (4Shin JI Park JM Lee SM et al.Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome.Pediatr Nephrol. 2005; 20: 609-613Crossref PubMed Scopus (91) Google Scholar) demonstrated that aortomesenteric compression could resolve spontaneously within a relatively short time (mean, 1.4 y; range, 0.5–3.5 y) as a result of physical development during childhood. Although a major factor affecting the decrease of the peak flow velocity in the aortomesenteric portion of the left renal vein was the increase in body mass index, the increase in diameters of the left renal vein by growth might also influence the renal hemodynamics. These findings suggest that the first therapy for hematuria of childhood nutcracker syndrome should be observation. However, in our study, some patients showed persistent hematuria despite the decrease of the peak velocity in the aortomesenteric portion of the left renal vein, indicating that these patients might require therapy. Therefore, we believe that endovascular stent placement should be considered when this syndrome leads to persistent clinical symptoms after a sufficiently long period of observation, and should be guided by the clinical, radiologic, and renal hemodynamic findings. We suggest that the period of observation should be at least 2 to 3 years, because 15 of the 20 patients with nutcracker syndrome (75%) showed complete resolution of hematuria within 3 years of follow-up. Further studies and long-term follow-up are necessary before endovascular stent placement is accepted for the treatment of childhood nutcracker syndrome." @default.
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- W2115379576 title "Re: Endovascular Stent Placement for the Treatment of Nutcracker Phenomenon in Three Pediatric Patients" @default.
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