BALTIMORE — Lower back pain, fatigue, and nausea are all symptoms that could be caused by any number of illnesses.
But they're also the hallmark signs of a serious condition called Nutcracker Syndrome.
It's when the veins in the lower abdomen are squeezed and restrict blood flow.
For more than a decade, 35 year old Kristine Sohn often felt fatigue or pain in her side and back.
Then two years ago, new symptoms that were even more troubling.
"For about six months I was experiencing blood in the urine," she said.
Her husband Eric, that was a turning point.
"By the time blood in the urine became an issue we had already dealt with so many other things that it was one of those, okay, well now we have a clue that we could start looking towards," he remembered.
Kristine was referred to Baltimore Mercy Medical Center vascular surgeon, Dr. Kurtis Kim, who diagnosed Kristine with Nutcracker Syndrome.
"So, you could imagine the nutcracker being cracked like this, where the renal vein gets really gets compressed here," said Dr. Kim.
To relieve the pressure Dr. Kim threaded a small tube through a catheter into Kristine's abdomen, to perform what's called extra vascular stenting.
"The stent, or graft that goes outside of the vein, so that the compression, whatever is compressing, it is lifted up," he explained.
"It was very, very painless, very minimal," said Kristine.
In fact, just eight weeks later, Kristine and Eric were once again teamed up on rooftops.
How is it diagnosed?
Some common symptoms of Nutcracker Syndrome include:
- blood in the urine
- pelvic pain
- pain in the side or abdomen
- protein in the urine, which can be determined by a doctor
- pain during intercourse
- enlarged veins in testicles
- lightheadedness while standing, but not while sitting
A doctor will perform a physical exam and take a medical history and ask about symptoms to help narrow down a diagnosis.
If Nutcracker Syndrome is suspected, the doctor will take urine samples to look for blood, protein, and bacteria.
Next, the doctor may recommend a Doppler ultrasound of the kidney area to see if there's any abnormal blood flow through the veins and arteries.
A CT scan or MRI may be recommended to look more closely at the kidneys, blood vessels, and other organs to see exactly where and why the vein is compressed.
Least invasive treatment
The most widely used treatment options for Nutcracker Syndrome include open vascular approaches, laparoscopic techniques, and the placement of endovascular stents.
Laparoscopic techniques, compared with open surgeries, are less invasive and associated with reduced post-operative morbidity.
Vascular stent treatment, including the placement of both internal and external vascular stents, has become a desirable option that is minimally invasive with good results.
Improvements have been seen in left renal vein diameter after placement of stents, as well as in the peak velocity ratio and renocaval pressure gradient in many patients.
However, the stenting treatment is not without risks.
Complications can include incorrect stent placement and stent migration requiring surgical intervention.