Methods
A literature search was conducted through PubMed, SCOPUS, and Cochrane Databases from October 2012 to October 2022 for all confirmed cases of Nutcracker Syndrome. Additionally, seven cases from our own institution were included. Informed consent was not obtained as there are no identifiable patient factors in any of the records reviewed.
Selection Criteria: The PRISMA diagram (figure 1) describes the selection process. All case reports and case series involving patients with confirmed diagnosis of NCS were included for screening. Systematic reviews, meta-analyses, and other types of papers were excluded with one exception. A systematic review that contained an individual case report was included, but only data from the case report was used in our review. [35] Reports of pediatric patients (under age 18) were excluded, as were reports in languages other than English and those where NCS was not ultimately diagnosed. Reports with incomplete patient data were also excluded. Most articles were excluded by screening abstracts but several full text articles were also excluded for the above reasons after review. Seven cases from our own institution were included. Ultimately, 40 articles were included.
Data Extraction: The following data was retrieved and appears in table 1: lead author, year of publication, country of origin, age, sex, presenting symptoms, diagnostic tests, location of the compression, presence of pelvic venous dilation, and type of treatment or procedure.
Statistical Analysis: Descriptive statistics were used to present the demographic, clinical, pathologic and treatment features of the pooled data from all the selected studies. This appears in the body of the paper below and in table 2.