ReviewJournal of vascular surgery. Venous and lymphatic disorders2025
Nutcracker syndrome (a Delphi consensus).
Review in Journal of vascular surgery. Venous and lymphatic disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Nutcracker syndrome with pelvic congestion syndrome: A case report.Radiology case reports · 2026Article
- Use of the Wrapsody™ Cell-Impermeable Endoprosthesis for the treatment of pelvic congestion syndrome due to nutcracker syndrome.CVIR endovascular · 2026Article
- Stenting for symptomatic left renal vein compression in patients with complex pelvic venous disease is safe on long-term follow-up.Journal of vascular surgery. Venous and lymphatic disorders · 2026Article
- Open surgery appears to be the preferred treatment in patients with nutcracker syndrome: A vascular low frequency disease consortium analysis.Journal of vascular surgery. Venous and lymphatic disorders · 2026Article
- The continuing challenge of Nutcracker syndrome.Journal of vascular surgery. Venous and lymphatic disorders · 2026Article
- Intracardiac migration of a left renal vein stent after endovascular treatment of nutcracker-associated pelvic congestion syndrome: a case report.BMC surgery · 2026Article
- Laparoscopic and robotic extravascular stenting of the left renal vein for anterior nutcracker syndrome in a single-center series.Journal of vascular surgery. Venous and lymphatic disorders · 2026Article
- Nutcracker syndrome in 2026: a nephrologist-oriented diagnosis and management.Clinical kidney journal · 2026Review
- An Overview of Vascular Compression Syndromes and Associations with Autonomic Dysfunction: A Review.Biomedicines · 2026Review
- Using finite element analysis to obtain the pressure gradient between the left renal vein and the inferior vena cava: a new method for the diagnosis and follow-up of patients with nutcracker syndrome.Quantitative imaging in medicine and surgery · 2026Article
- Reoperative robotic laparoscopic extracorporeal stent implantation following the failure of endovascular stent implantation for nutcracker syndrome.Journal of vascular surgery cases and innovative techniques · 2026Article
- Surgical management of Nutcracker syndrome caused by a middle mesenteric artery in an adolescent.Journal of vascular surgery cases and innovative techniques · 2026Article
- Case Report: A rare coexistence with severe aortic root dilatation and nutcracker phenomenon in pediatric Marfan syndrome.Frontiers in pediatrics · 2026Article
- Numerical simulation of gonadal vein hemodynamics in nutcracker syndrome-associated varicocele: effects of Valsalva maneuver and clinical implications.Frontiers in bioengineering and biotechnology · 2026Article
- Left renal vein transposition as a treatment of refractory hypertension in nutcracker syndrome.Journal of vascular surgery cases and innovative techniques · 2025Article
- Beyond bladder clots: Unmasking nutcracker syndrome in refractory hematuria: A case report.Radiology case reports · 2025Article
- Breaking the Nutcracker: a case-based review of diagnosis and surgical treatment.Journal of surgical case reports · 2025Article
- Robotic-Assisted Vascular Surgery: Current Landscape, Challenges, and Future Directions.Journal of clinical medicine · 2025Review
- Robotic-assisted laparoscopic transposition of the left renal vein with three-dimensional image reconstruction for treatment of pediatric nutcracker syndrome: a case description and literature analysis.Quantitative imaging in medicine and surgery · 2025Article
- Surgical treatment of nutcracker syndrome in Sub-Saharan Africa: Mid-term outcomes from a six-case series in Benin.International journal of surgery case reports · 2025Article
Corrections and comments
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Authors and funding
21 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNutcracker syndrome (NCS) describes the symptomatic compression of the left renal vein between the aorta and superior mesenteric artery. Whereas asymptomatic compression is a common radiological finding, patients with NCS can report a range of symptoms. There are no specific diagnostic criteria and interventions include a range of open surgical and endovascular procedures. Therefore, we wished to develop an international consensus document covering aspects of diagnosis, management, and follow-up for patients with NCS.
methodsA three-stage modified Delphi consensus was performed. A steering committee developed 37 statements covering 3 categories for patients with NCS: diagnosis, management, and follow-up. These statements were reported individually by 20 international experts in the management of venous disease, using a 5-point Likert scale. Consensus was defined if ≥70% of respondents rated the statement between 1 and 2 (agreement) and between 4 and 5 (disagreement). Those statements without consensus were recirculated in a second round of voting. A third round of the questionnaire was performed with 14 additional statements to clarify diagnostic values of NCS.
resultsResponses were returned by 20 of 20 experts (100%) in round one and 17 of 20 (85%) in round two. Initial consensus was reached in 24 of 37 statements (65%) spread over all categories. Round two achieved a further consensus on 5 out of 10 statements (50%). No categories reported consensus on all statements. In round two consensus was reached in the category of follow-up (4/5 statements [80%]). The final round reached consensus on 5 out of 14 statements (36%). Experts agreed that imaging is obligated to confirm NCS. Experts did not agree on specific diagnostic cut-off values. There was a consensus that the first choice of operative treatment is left renal vein transposition and that the risk of stent migration outweighs the advantages of a percutaneous procedure.
conclusionsConsensus was achieved on most statements concerning the assessment and management of NCS. This Delphi consensus identified those areas in which further research is needed, such as antiplatelet therapy, endovascular treatment, and renal autotransplantation. A rare disease registry to improve data and reports of patient outcomes is warranted.
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