Heart and Vascular Health Nutcracker Syndrome: Symptoms, Risk Factors, and Treatments By Heart and Vascular Institute, November 9, 2016 Does the term “nutcracker syndrome” make you think of a holiday keepsake? This rare vascular disorder can cause pain and other symptoms but can be difficult to diagnose. What Is Nutcracker Syndrome? In nutcracker syndrome, your left renal vein gets compressed by two nearby arteries in your abdomen. Your left renal vein carries blood out of your left kidney and into your inferior vena cava, your body’s largest vein, so it can flow back up to your heart. The condition is called “nutcracker syndrome” because of how the arteries look as they compress the vein, like a nutcracker crushing a nut. RELATED: 3 Heart and Vascular Conditions You Don’t Want for Christmas This Year Nutcracker Syndrome Symptoms When your left renal vein gets compressed, blood cannot flow through it properly. Blood can pool and flow backward into nearby veins, causing swelling and leading to symptoms that can include: Abdominal (flank) pain Blood in your urine Symptoms of nutcracker syndrome that occur in women are: Pelvic congestion syndrome, or varicose veins in the lower abdomen that can cause pain. Heaviness in the pelvic or genital area. Pain with sexual intercourse. Painful menstrual periods. In men, symptoms appear as varicoceles or enlarged veins in the scrotum. Some people have no symptoms, while others may have severe symptoms that affect them every day. RELATED: What Is Vascular Disease? Am I At Risk for Nutcracker Syndrome? While nutcracker syndrome can affect anyone, it is most common in women in their 30s and 40s who are tall and slim. It can sometimes appear after rapid weight loss, or after pregnancy. Nutcracker Syndrome Diagnosis Nutcracker syndrome can be difficult to diagnose because its symptoms are similar to many other urological and gynecological disorders. Once other conditions have been ruled out, your vascular surgeon may recommend imaging tests, like an ultrasound, CT scan, or MRI to screen for nutcracker syndrome. Nutcracker Syndrome Treatment Options Nutcracker syndrome can be treated, and treatments depend on your age, anatomy, and symptoms. In some cases, nutcracker syndrome may not need treatment, especially for patients who are: 18 years old or younger, as the condition may resolve itself as the patient grows. Adults with mild symptoms. Treatments for nutcracker syndrome can include: Regular urinalysis, to check for blood in your urine. Stenting, which uses a tube made of metal mesh to hold your vein open and allow for healthy blood flow. Surgery to relieve the pressure on your vein. To learn more about nutcracker syndrome, contact the UPMC Division of Vascular Surgery at (412) 802-3333.