Multiple vascular anomalies may be encountered in patients with nutcracker syndrome; further compounding the surgical complexity in managing this condition. A 28-year-old male presented with persistent flank pain and hematuria. Imaging revealed narrowing of the left renal vein at the aortomesenteric junction. and a dilated vein consistent with the left gonadal vein. https://www.extrabutternyers.shop/product-category/dress-shoes-and-loafers/