Book review

https://doi.org/10.20471/acc.2022.61.01.17

Successful Resolution of Nutcracker Syndrome with 3D Printed PEEK Extravascular Stent in an Adolescent Boy

Da-li He ; Department of Urology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Heng-en Wang ; Department of Urology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Yong Jiao ; Department of Urology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Bin Wu ; Department of Urology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Dong Cui ; Department of Urology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Yan-yan Li ; Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Yong Yang ; Department of Ultrasonic Diagnosis, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China
Tie-sheng Cao ; 3D Printing Research Center, Air Force Military Medical University, Xi’an, Shaanxi, China
Vinko Vidjak ; Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
Danko Milošević ; University of Zagreb School of Medicine, Zagreb, Croatia; Zabok General Hospital and Croatian Veterans Hospital, Zabok, Croati
Bo Zhang ; Department of Urology, Tangdu Hospital, Air Force Military Medical University, Xi’an, Shaanxi, China

Abstract

Three-dimensional printed polyetheretherketone (PEEK) extravascular stent was
applied to treat a 14-year-old boy with nutcracker syndrome. Digital subtraction angiography revealed
a segment of the left renal vein (LRV) with reduced contrast filling immediately before its inflow into
the inferior vena cava, and high-pressure gradient. The three-dimensional reconstruction model demonstrated
that the LRV and the duodenum were contracted at the aortomesenteric angle, resulting in LRV
compression from the abnormal high-level duodenal compartment. When duodenum courses between
the abdominal aorta and superior mesenteric artery (duodenal interposition), the LRV entrapment occurs
even at <90 aortomesenteric degrees. Three-dimensional printed PEEK extravascular stent was
chosen to elevate the superior mesenteric artery and lower the duodenum position, thus relieving LRV
compression. This extravascular application has significant advantages over open surgery, endovascular
stenting and artificial vessel procedures with expanded polytetrafluoroethylene. It provides better cellular
vitality by ensuring soft tissue proliferation. By reducing external acceleration and centrifugal force, a
three-dimensional printed PEEK extravascular stent reduces adverse side effects. Such a stent has a
distinctive personalized design, good stiffness, and durability that allows blood vessel growth, preventing
stent migration and thrombosis. Therefore, it is suitable for both adult and pediatric patients. According
to the abdominal ultrasound and multi-slice computed tomography scan, the postoperative follow-up
results were satisfactory one year after surgery. The patient felt well, the blood flow in the LRV was not
obstructed, and the blood flow velocity was average. The external stent was in place.

Keywords

Nutcracker syndrome; Three-dimensional printing; Polyetheretherketone; Extravascular stent; Laparoscopy

Hrčak ID:

280281

URI

https://hrcak.srce.hr/280281

Publication date:

1.3.2022.

Article data in other languages: croatian

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