Treatment depends on the severity and symptoms. In addition to conservative measures, more invasive therapies include endovascular stenting, renal vein re-implantation, and gonadal vein embolization. The decision between conservative and surgical management is dependent on the severity of the symptoms. Conservative management is used if the patient is a child and the hematuria is mild. In contrast, more severe symptoms such as reduced renal function, flank pain, and anemia are managed with surgical interventions. Conservative management Conservative management is advised in children as further growth may lead to an increase in tissue at the fork between the SMA and AA, providing room for the LRV to pass blood without obstruction. Treatment in this case involves weight gain to build more adipose tissue, decreasing the compression. Venous blood may also be directed towards veins formed as a result of the higher blood pressure, which may contribute to symptomatic relief for individuals as they age. 75% of adolescent patients have been found to have their symptoms resolved after two years. Medications that decrease blood pressure such as ACE inhibitors can also be used to reduce the proteinuria. Surgical management Open and laparoscopic procedures There are several different procedures available to manage NCS include: * LRV transposition: The LRV is moved higher in the abdomen and re-implanted to the inferior vena cava (IVC) so that it is no longer being compressed. * Gonadal vein transposition: The gonadal veins are connected to the (IVC) to reduce the amount of blood backed up in the pelvis. * Renocaval bypass with saphenous vein: a segment of the great saphenous vein is used as a second connection between the LRV and the IVC to alleviate pressure build up. * Renal autotransplantation: transfer of a kidney from its original location into the body to another location to prevent venous compression. LRV transposition is the most common procedure done followed by renal autotransplantation and LRV bypass. In all cases for open procedures, data is limited for long term follow-up. With respect to LRV transposition, most patients stated improvement of symptoms 70 months following the procedure. Laparoscopic procedures involve laparoscopic spleno-renal venous bypass and laparoscopic LRV-IVC transposition. They are uncommon in comparison to open procedures, but the outcomes of such procedures are similar to those of open procedures. Although robotic surgery is possible, data on robotic procedures is limited concerning outcomes and cost-effectiveness. Endovascular procedures Endovascular interventions involve the use of stents to improve blood flow in the area of LRV impingement. Following catheterization, venography is done to visualize the vasculature and can provide confirmatory diagnosis of NCS prior to stenting. Following stenting, 97% of patients have had improvement of symptoms by sixth months following the procedure, and long term follow-up showed no recurrence of symptoms after 66 months. Although less invasive, risks involved include incorrect placement of the stent as well as stent dislodging and migration to the right atrium. Furthermore, patients must be on anticoagulation therapy after stenting for three months.
Nutcracker syndrome
Wieacker syndrome
MASS syndrome
Emmonsiosis
Pellegrini–Stieda syndrome
Riddoch syndrome
Aortoenteric fistula
EAST syndrome