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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. To our knowledge, this is the fourth case presenting the coexistence of the two syndromes in the literature and the first presenting the modified treatment approach.<\/jats:p>","DOI":"10.1136\/bcr-2024-263818","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T13:05:26Z","timestamp":1739451926000},"page":"e263818","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Left renal vein transposition using autologous gonadal vein graft in patient with combined anterior nutcracker and May-Thurner syndromes"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7137-7902","authenticated-orcid":false,"given":"Theoklis Andrea","family":"Kouyialis","sequence":"first","affiliation":[{"name":"Nicosia General Hospital, Nicosia, Cyprus"},{"name":"University of Edinburgh Medical School, Edinburgh, Midlothian, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios","family":"Zertalis","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology, Aretaeio Private Hospital, Strovolos, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolas","family":"Charalambous","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology, Aretaeio Private Hospital, Strovolos, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Papoulas","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery, Nicosia General Hospital, Nicosia, Cyprus"},{"name":"Department of Surgery, Aretaeio Private Hospital, Strovolos, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"2025082722393391000_18.2.e263818.1","doi-asserted-by":"crossref","first-page":"5056","DOI":"10.1097\/MS9.0000000000001182","article-title":"Anterior Nutcracker syndrome in a young male patient: a case report and review of literature","volume":"85","author":"Hamdan","year":"2023","journal-title":"Ann Med Surg (Lond)"},{"key":"2025082722393391000_18.2.e263818.2","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1590\/1677-5449.012417","article-title":"Diagn\u00f3stico e tratamento da s\u00edndrome de quebra-nozes (nutcracker): revis\u00e3o dos \u00faltimos 10 anos","volume":"17","author":"Macedo","year":"2018","journal-title":"J vasc bras"},{"key":"2025082722393391000_18.2.e263818.3","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1590\/s1677-5538.ibju.2016.0517","article-title":"Nutcracker syndrome: how are we cracking the nuts and whose nuts are we cracking?","volume":"43","author":"Korkes","year":"2017","journal-title":"Int Braz J Urol"},{"key":"2025082722393391000_18.2.e263818.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.09.051"},{"key":"2025082722393391000_18.2.e263818.5","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics13081433","article-title":"Anterior and Posterior Nutcracker Syndrome Combined with May-Thurner Syndrome: First Report of This Unique Case","volume":"13","author":"Tiralongo","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"2025082722393391000_18.2.e263818.6","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1055\/s-0033-1348883","article-title":"Renosplenic shunting in the nutcracker phenomenon: a discussion and paradigm shift in options? 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