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], = NS), the peak velocity ratio (6 [5-7, IQR] vs 4.8 [4.8-5.8], = NS), beak angle (27° [24-30, IQR] vs 29° [24-32]; = NS), and aortomesenteric angle (26° [23-29, IQR] vs 28° [24-30]; = 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.