Decision analysis of left renal vein stenting and renal autotransplantation for Nutcracker syndrome

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-08-10 DOI:10.1016/j.amjsurg.2025.116567

Armaun D. Rouhi , Marissa Di Napoli , Hanya Yang , Thomas Pshak , Maria Baimas-George , Rose Castle , Trevor L. Nydam , Rashikh A. Choudhury

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引用次数: 0

Abstract

Introduction

Management strategies for Nutcracker syndrome (NCS) differ across vascular and transplant surgery, with options such as left renal vein stenting and renal autotransplantation offering potential long-term pain relief.

Methods

A decision-analytic Markov state transition model was generated to simulate NCS management strategies over a two-year time horizon: Stent First, Autotransplantation, Stent Only, and No Intervention.

Results

Autotransplantation achieved the highest rate of pain resolution at 77.0 % followed by Stent First at 64.9 % after two years. Stent Only and No Intervention demonstrated the lowest rates of pain resolution at 51.8 % and 0 %, respectively. The estimated cumulative morphine milligram equivalents (MMEs) over the simulated two-year period were approximately 5037 MMEs for Autotransplantation, 7684 MMEs for Stent First, 10,556 MMEs for Stent Only, and 21,900 MMEs for No Intervention.

Conclusion

Renal autotransplantation was associated with higher rates of pain resolution and lower opioid usage over a simulated two-year period.

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左肾静脉支架置入术与自体肾移植治疗胡桃夹子综合征的决策分析

胡桃夹子综合征（NCS）的治疗策略因血管手术和移植手术的不同而不同，如左肾静脉支架置入术和肾脏自体移植术可以提供潜在的长期疼痛缓解。方法建立决策分析马尔可夫状态转换模型，模拟两年内NCS管理策略：支架优先、自体移植、仅支架和无干预。结果自体移植术后2年疼痛缓解率最高，为77.0%，其次为支架移植，为64.9%。仅支架组和不介入组疼痛缓解率最低，分别为51.8%和0%。在模拟的两年期间，估计累积吗啡毫克当量（MMEs）为：自体移植约5037 MMEs，支架优先约7684 MMEs，仅支架约10556 MMEs，无干预约21,900 MMEs。结论在模拟的两年时间内，自体肾移植与更高的疼痛缓解率和更低的阿片类药物使用相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.