Autotransplantation for circum-aortic left renal vein compression after failed left renal vein transposition.

Circum-aortic nutcracker syndrome is a rare form of left renal vein compression with limited evidence to guide management. We present two sibling patients with complex renal vein anatomy who had persistent symptoms despite initial left renal vein transposition. Both underwent renal autotransplantation after recurrence of flank and abdominal pain, with imaging demonstrating ongoing compression and collateralization. Following autotransplantation, both patients experienced sustained symptom resolution and preserved renal function at follow-up.