ABSTRACT
Nutcracker syndrome often initially presents with left flank pain and intermittent hematuria. Gross or microscopic hematuria and dysuria are well described and most often associated with nutcracker syndrome. Identifying and controlling the mechanisms when possible are important steps in the treatment of patients with pelvic venous congestion syndrome. Complaints of heaviness and/or edema of the left lower extremity should raise suspicion of May–Thurner syndrome, with or without deep venous thrombosis. The outcomes of the treatment of pelvic venous congestion syndrome when history, physical examination, and venographic findings are in concert are excellent. A transverse linear defect in either the left renal vein or the left common iliac vein suggests nutcracker syndrome and May–Thurner syndrome, respectively. Perineal and vulvar reflux can contribute to recurrent varicose veins.
