ABSTRACT
This chapter reviews the clinical presentation and evaluation of patients with Nutcracker syndrome (NS). It discusses treatment options, including observation and medical management and open surgical, endovascular, and hybrid interventions. The symptoms of NS can be quite incapacitating in many patients. NS has been attributed to those patients who present with a nutcracker phenomenon and with signs or symptoms of left renal vein (LRV) congestion. Patients most frequently present with hematuria and left flank pain or pelvic pain. Patients are usually discharged on low-molecular-weight heparin and warfarin and maintained on oral anticoagulation for a period of 3 months until the first post-operative visit. If improvement of symptoms and patency of the LRV are confirmed, the next visit is set-up for 6 months later, or whenever the patient demonstrates any recurrence of symptoms. LRV compression can be confirmed with cross-sectional imaging studies such as computed tomography venography and magnetic resonance venography.
