Left renal vein transposition using autologous gonadal vein graft in patient with combined anterior nutcracker and May-Thurner syndromes.

Anterior nutcracker syndrome (ANCS) and May-Thurner syndrome (MTS) are part of a rare group of vascular compression syndromes where extrinsic compression of arteries or veins results in non-specific clinical presentation posing diagnostic and management challenges. We present the case of a female patient in her early 40s with a 3 year history of left flank and pelvic pain, left leg swelling and microscopic haematuria attributed to a rare combination of ANCS and MTS. Compression of the left common iliac vein (MTS) was managed with left common iliac stenting and compression of the left renal vein (LRV; ANCS) was managed surgically with a novel modified technique of LRV transposition using an autologous gonadal vein graft with subsequent resolution of all symptoms.