Objective A retrospective study was undertaken to examine therapeutic strategies used in 6 patients with left renal venal nutcracker phenomenon.Methods Three patients underwent surgical transposition of the superior mesenteric artery. Three patients underwent endograft stent implantations with intervention.Results All 6 cases were completely relieved of left renal vein compression after the operations, leading to improved clinical symptoms and normal urine tests.Conclusions Transposition of the superior mesenteric artery is a feasible method, but leads to complications and great trauma. Treating left renal venal nutcracker phenomenon with endografting techniques is minimally invasive in certain cases, and seems to have a prospective future. Objective A retrospective study was undertaken to examine therapeutic strategies used in 6 patients with left renal venal nutcracker phenomenon. Methods Three patients underwent surgical transposition of the superior mesenteric artery. Three patients underwent endograft stent implants with intervention. Results All 6 cases were completely relieved of left renal vein compression after the operations, leading to improved clinical symptoms and normal urine tests. Conclusions Transposition of the superior mesenteric artery is a feasible method, but leads to complications and great trauma. Treating left renal venal nutcracker phenomenon with endografting techniques is minimally invasive in certain cases, and seems to have a prospective future.