Complications of Endovascular Treatment in Patients with Nutcracker Syndrome: A Literature Review

Abstract

Nutcracker Syndrome, a rare anatomical condition, consists of the compression of the Left Renal Vein as it passes at the Aortomesenteric level and results in nonspecific signs and symptoms. Its exact prevalence is unknown and can present at any age, with a peak prevalence between the second and third decade. Its diagnosis is of exclusion and is primarily through imaging tests, with Venography and pressure gradient measurement being the gold standard. Treatment varies according to clinical severity, ranging from conservative measures to surgical approach, either open or endovascular. The latter, despite being safer, can present various complications. In view of this, a literature review was conducted to analyze potential complications of endovascular treatment for Nutcracker Syndrome. A total of 21 articles correlating the complications of endovascular treatment for patients with this syndrome were found and included. Most studies presented restenosis, local fibromuscular hyperplasia, erosion, thrombus occlusion, and stent migration as the main and most common complications. Stent migration can lead to worse outcomes necessitating surgical reapproach. Nutcracker Syndrome, being rare, has few studies that follow the long-term outcomes of possible treatments. Among these, endovascular treatment is currently the most recommended as it is minimally invasive, but it is not failure-free, necessitating individualized stent choice and follow-up to reduce the incidence of various complications.