Left spermatic-external iliac vein bypass combined with ligation of spermatic vein in the treatment of nutcracker syndrome with varicocele

DAI Xiaofei; SUN Xiaojun; ZHANG Xun; LI Jingmin; CUI Liang

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Medical Journal of the Chinese People Armed Police Forces ›› 2021, Vol. 32 ›› Issue (6) : 476-479.

Left spermatic-external iliac vein bypass combined with ligation of spermatic vein in the treatment of nutcracker syndrome with varicocele

DAI Xiaofei, SUN Xiaojun, ZHANG Xun, LI Jingmin, CUI Liang

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Abstract

Objective To summarize the clinical features of and surgical approaches to nutcracker syndrome (NCS) with moderate and severe left varicocele (VC). Methods The clinical data on 8 patients of NCS with left VC admitted to our hospital between July 2012 and July 2019 was retrospectively analyzed. The age of these patients ranged from 15 to 54 (mean 25 years old). The average body mass index was 18.3. The clinical manifestations were scrotal swelling and pain. Physical examination showed moderate to severe left VC while semen analysis pointed to oligospermia or asthenospermia. Routine urine tests showed microscopic haematuria (+-+++) and proteinuria (+-++). Ultrasonography and enhanced abdominal CT showed compression of the left renal vein due to the narrowing of the angle between the abdominal aorta and superior mesenteric artery, with an average angle of 23.4°. Left renalvein hilar diameter to aortomesenteric diameter ratio was high,with an average of 5.1. All patients received left spermatic-external iliac vein bypass combined with high ligation of left VC. During the surgery, the left spermatic vein was cut off retroperitoneally, the proximal end was anastomosed with the left external iliac vein end-to-side, and the distal end was ligated. Results All the operations were successful without such complications as incision infection or thrombosis. After 6 months of follow-up, it was found that scrotal symptoms and regurgitation of the spermatic vein had disappeared, so had haematuria and proteinuria. The postoperative ratio of the left renal vein hilar diameter to the aortomesenteric diameter ratio and the sperm motility a+b ratio were significantly improved (P<0.001), but sperm density did not change significantly (P=0.05). Conclusions NCS is a rare disease, which is often associated with VC, hematuria and proteinuria. Left spermatic-external iliac vein bypass combined with ligation of the spermatic vein is a safe and effective treatment of NCS with VC.

Key words

nutcracker syndrome / varicocele / venous anastomosis / external iliac venous bypass

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DAI Xiaofei, SUN Xiaojun, ZHANG Xun, LI Jingmin, CUI Liang. Left spermatic-external iliac vein bypass combined with ligation of spermatic vein in the treatment of nutcracker syndrome with varicocele[J]. Medical Journal of the Chinese People Armed Police Forces. 2021, 32(6): 476-479

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