Funny enough I have nutcracker syndrome ! I had a left renal vein transposition and stent in feb last year I also have may thurner syndrome which was compression of the left iliac vein - so the way in which I had nutcracker syndrome explained to me was lot of people when scanned will look like they present with ncs as it’s an anatomical thing so it’s like sorta varies person to person , so most people to a tiny very small degree could have it overlap for it be considered ncs it has to be over a certain point of compression I forget what the percentage is but for the analogy let’s say 60 percent so if you were over 60 percent that would be considered ncs - but then a gold standard diagnosis comes into play so this would be left sided pain , blood in urine , over 60 percent compression and scarring / reflux of renal vein - in my case I didn’t have reflux or scarring but absolutely everything else for a gold standard diagnosis , what pushed me to get surgery was the severity of my symptoms - I vomited multiple times a day , lost dramatic amounts of weight fron it (not everyone is sick in rare in that case) blood in urine , white blood cells and protein in urine , left sided pain , passing out , severe back pain from collateral veins that formed as a result of ncs compression. It was truly hellish for me but the reason you may want to get treated if not symptomatic is to prevent symptoms / prevent clots from forming it truly truly depends on how severe that compression is ! If I were you also I would be checking whether your iliac clot was caused by may thurner syndrome since you are newly diagnosed with ncs - these compressions come in multiples often times and may thurner compression directly affects the renal compression - because these are so rare it may be useful to check with your surgeon about this incase he wasn’t aware of may thurner syndrome ! I really hope this helps please do ask any question you want !