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Nutcracker syndrome

Guidelines

Key sources

The following summarized guidelines for the management of nutcracker syndrome are prepared by our editorial team based on guidelines from the European Society for Vascular Surgery (ESVS 2025).
1

Medical management

Conservative management: as per ESVS 2025 guidelines, offer conservative management in patients with an established diagnosis of nutcracker syndrome who have mild symptoms.
B
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Therapeutic procedures

Endovascular stenting: as per ESVS 2025 guidelines, consider performing endovascular stenting in selected patients with an established diagnosis of nutcracker syndrome who experience severe symptoms.
C
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Surgical interventions

Indications for surgery: as per ESVS 2025 guidelines, consider performing open surgical treatment with left renal vein transposition in patients with an established diagnosis of nutcracker syndrome who experience severe symptoms.
C
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