{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:56:41Z","timestamp":1789765001613,"version":"4.0.1"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Nutcracker syndrome is a rare condition caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. This results in increased venous pressure, leading to haematuria, flank pain, and pelvic discomfort, particularly in individuals with low body mass index. Diagnosis is often challenging due to nonspecific symptoms and overlap with other pelvic disorders. We report a case of a 49-year-old woman with persistent left flank pain, dysmenorrhea, and recurrent vaginal bleeding. Imaging confirmed compression of the left renal vein. A conservative approach with nutritional support was initially attempted, but due to ongoing symptoms, the patient underwent surgical transposition of the vein with patch angioplasty using bovine pericardium. This case underscores the need to consider Nutcracker syndrome in patients with unexplained haematuria and flank pain, especially in underweight women. We also review current diagnostic tools and treatment options for this uncommon vascular condition.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf920","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:30:08Z","timestamp":1763555408000},"source":"Crossref","is-referenced-by-count":1,"title":["Breaking the Nutcracker: a case-based review of diagnosis and surgical treatment"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2252-9872","authenticated-orcid":false,"given":"Roberto","family":"Cunha","sequence":"first","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo de Ponta Delgada , Ponta Delgada, S\u00e3o Miguel\u2014Azores ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Basilio","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Unidade Local de Sa\u00fade de Vila Nova de Gaia e Espinho , Vila Nova de Gaia ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Unidade Local de Sa\u00fade de Vila Nova de Gaia e Espinho , Vila Nova de Gaia ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitor","family":"Martins","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Unidade Local de Sa\u00fade de Vila Nova de Gaia e Espinho , Vila Nova de Gaia ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Canedo","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Unidade Local de Sa\u00fade de Vila Nova de Gaia e Espinho , Vila Nova de Gaia ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2025111907300225900_ref1","doi-asserted-by":"crossref","first-page":"101344","DOI":"10.1016\/j.jvscit.2023.101344","article-title":"How I treat nutcracker syndrome","volume":"9","author":"Duncan","year":"2023","journal-title":"J Vasc Surg Cases Innov Tech"},{"key":"2025111907300225900_ref2","doi-asserted-by":"publisher","author":"","DOI":"10.1016\/j.jvsv.2024.101970"},{"key":"2025111907300225900_ref3","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ejvssr.2018.09.003","article-title":"Surgical treatment of a patient with nutcracker syndrome via transposition of the left renal vein","volume":"41","author":"Denchev","year":"2018","journal-title":"EJVES Short Rep"},{"key":"2025111907300225900_ref4","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.ejvs.2017.02.015","article-title":"Nutcracker syndrome: an update on current diagnostic criteria and management guidelines","volume":"53","author":"Ananthan","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025111907300225900_ref5","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jvsv.2017.11.005","article-title":"A systematic review on management of nutcracker syndrome","volume":"6","author":"Velasquez","year":"2018","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"2025111907300225900_ref6","doi-asserted-by":"publisher","DOI":"10.1186\/s42155-025-00544-z","article-title":"Controversies in treating nutcracker syndrome","volume":"8","author":"Peri\u0107","year":"2025","journal-title":"CVIR Endovasc"},{"key":"2025111907300225900_ref7","doi-asserted-by":"crossref","first-page":"1140149","DOI":"10.21037\/cdt-20-160","article-title":"Nutcracker syndrome: diagnosis and therapy","volume":"11","author":"Kolber","year":"2021","journal-title":"Cardiovasc Diagn Ther"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/11\/rjaf920\/65377748\/rjaf920.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/11\/rjaf920\/65377748\/rjaf920.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:30:09Z","timestamp":1763555409000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf920\/8327112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":7,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf920","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,11]]},"article-number":"rjaf920"}}