Outcomes of conservative management in patients with nutcracker syndrome

Objective This study aims to evaluate outcomes in nutcracker syndrome patients with tolerable symptoms and treated conservatively without invasive interventions.Methods This prospective study included patients treated conservatively. Promoting weight gain, the endpoint of the study was spontaneous resolution of symptoms.Results Sixteen patients (75% female and mean age 24.4 +/- 3.5 years) underwent conservative management. Over a mean follow-up of 27.3 months [13-42, interquartile range (IQR)], the diameter ratio (5.5 [5-6.5, IQR] vs 4.3 [4.1-6], p = NS), the peak velocity ratio (6 [5-7, IQR] vs 4.8 [4.8-5.8], p = NS), beak angle (27 degrees [24-30, IQR] vs 29 degrees [24-32]; p = NS), and aortomesenteric angle (26 degrees [23-29, IQR] vs 28 degrees [24-30]; p = NS) exhibited no statistically significant changes. Complete resolution and improvement of symptoms were 28.5% and 31.4%, respectively, while 68.5% remained unchanged.Conclusions This study shows that a conservative approach contributes to the spontaneous improvement or complete resolution in young adult patients with mild symptoms.