Posterior nutcracker syndrome – A systematic review

Jae Hyon Park, Gi Hoon Lee, Seul Mi Lee, Michael Eisenhut, Andreas Kronbichler, Keum Hwa Lee, Jae Il Shin

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Summary: Posterior nutcracker syndrome (PNCS) is the entrapment of the left renal vein between the aorta and the vertebral column. Although uncommon, it is still an important diagnosis due to the high morbidity associated with the risk of secondary anaemia from haematuria, from long-term left renal vein hypertension, vascular thrombosis, and even blood clots in the urinary system. A literature search of PubMed and EMBASE databases was performed and 27 publications containing 27 cases were included for the final analysis. The following frequency of clinical signs and symptoms was noted: twenty-five patients had haematuria, 13 patients had flank pain, and two had hypertension. Overall, male-female distribution was balanced and there were more adult than paediatric (age < 18 years) patients. All symptoms of patients with conservative treatment were either well-controlled or under spontaneous resolution. Conservative management instead of surgical treatment should be preferred in most cases. Taken together, despite the low incidence of PNCS, its recognition and management are highly important. This systematic study explores the evidence base for conservative and medical options.

Original languageEnglish
Pages (from-to)23-29
Number of pages7
JournalVasa - European Journal of Vascular Medicine
Volume47
Issue number1
DOIs
Publication statusPublished - 2018 Jan

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Renal Veins
Hematuria
Thrombosis
Flank Pain
Renal Hypertension
PubMed
Signs and Symptoms
Blood Vessels
Aorta
Publications
Anemia
Spine
Databases
Pediatrics
Hypertension
Morbidity
Incidence
Conservative Treatment
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, J. H., Lee, G. H., Lee, S. M., Eisenhut, M., Kronbichler, A., Lee, K. H., & Shin, J. I. (2018). Posterior nutcracker syndrome – A systematic review. Vasa - European Journal of Vascular Medicine, 47(1), 23-29. https://doi.org/10.1024/0301-1526/a000670
Park, Jae Hyon ; Lee, Gi Hoon ; Lee, Seul Mi ; Eisenhut, Michael ; Kronbichler, Andreas ; Lee, Keum Hwa ; Shin, Jae Il. / Posterior nutcracker syndrome – A systematic review. In: Vasa - European Journal of Vascular Medicine. 2018 ; Vol. 47, No. 1. pp. 23-29.
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Park, JH, Lee, GH, Lee, SM, Eisenhut, M, Kronbichler, A, Lee, KH & Shin, JI 2018, 'Posterior nutcracker syndrome – A systematic review', Vasa - European Journal of Vascular Medicine, vol. 47, no. 1, pp. 23-29. https://doi.org/10.1024/0301-1526/a000670

Posterior nutcracker syndrome – A systematic review. / Park, Jae Hyon; Lee, Gi Hoon; Lee, Seul Mi; Eisenhut, Michael; Kronbichler, Andreas; Lee, Keum Hwa; Shin, Jae Il.

In: Vasa - European Journal of Vascular Medicine, Vol. 47, No. 1, 01.2018, p. 23-29.

Research output: Contribution to journalReview article

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AU - Shin, Jae Il

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N2 - Summary: Posterior nutcracker syndrome (PNCS) is the entrapment of the left renal vein between the aorta and the vertebral column. Although uncommon, it is still an important diagnosis due to the high morbidity associated with the risk of secondary anaemia from haematuria, from long-term left renal vein hypertension, vascular thrombosis, and even blood clots in the urinary system. A literature search of PubMed and EMBASE databases was performed and 27 publications containing 27 cases were included for the final analysis. The following frequency of clinical signs and symptoms was noted: twenty-five patients had haematuria, 13 patients had flank pain, and two had hypertension. Overall, male-female distribution was balanced and there were more adult than paediatric (age < 18 years) patients. All symptoms of patients with conservative treatment were either well-controlled or under spontaneous resolution. Conservative management instead of surgical treatment should be preferred in most cases. Taken together, despite the low incidence of PNCS, its recognition and management are highly important. This systematic study explores the evidence base for conservative and medical options.

AB - Summary: Posterior nutcracker syndrome (PNCS) is the entrapment of the left renal vein between the aorta and the vertebral column. Although uncommon, it is still an important diagnosis due to the high morbidity associated with the risk of secondary anaemia from haematuria, from long-term left renal vein hypertension, vascular thrombosis, and even blood clots in the urinary system. A literature search of PubMed and EMBASE databases was performed and 27 publications containing 27 cases were included for the final analysis. The following frequency of clinical signs and symptoms was noted: twenty-five patients had haematuria, 13 patients had flank pain, and two had hypertension. Overall, male-female distribution was balanced and there were more adult than paediatric (age < 18 years) patients. All symptoms of patients with conservative treatment were either well-controlled or under spontaneous resolution. Conservative management instead of surgical treatment should be preferred in most cases. Taken together, despite the low incidence of PNCS, its recognition and management are highly important. This systematic study explores the evidence base for conservative and medical options.

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Park JH, Lee GH, Lee SM, Eisenhut M, Kronbichler A, Lee KH et al. Posterior nutcracker syndrome – A systematic review. Vasa - European Journal of Vascular Medicine. 2018 Jan;47(1):23-29. https://doi.org/10.1024/0301-1526/a000670