Dr. Sclafani explains Nutcracker Syndrome-


NUTCRACKER SYNDROME IN CCSVI
The Nutcracker syndrome is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. Becasue of the obstruction, outflow from the renal vein must be by its collateral veins, namely the gonadal vein (ovarian or testicular vein) by tthe hemiazygous vein and the ascending lumbar vein. The outflow from the renal veins is very high, estimated to be about 400 milliliters per minute compared to cerebral venous blood flow 375 milliiters per minute.

increased gonadal vein flow results in incompetence of the gonadal vein valves and reflux into the ovary or testical leading to pain.

The Nutcracer syndrome is important iCCSVI. It worsens cerebrospinal venous blood flow. Because the hemiazygous vein and the ascending lumbar vein are primary outflow veins for the spinal veins, this large increase in flow at slightly higher pressures than that of the systemic vein can contribute to collateral overflow, especially if these veins are themselves obstructed, as in CCSVI.

The image shows that the renal vein flow into the inferior vena cava is diminished. There is very prompt and large flow into the ovarian vein and the hemiazygous vein in this patient.