3D-Printed PEEK Extravascular Stent in the Treatment of Nutcracker Syndrome: Imaging Evaluation and Short-Term Clinical Outcome

Abstract

Minimally invasive options are safe and reliable alternatives for the treatment of nutcracker syndrome (NCS). After continued efforts, our team successfully devised a new and effective therapeutic method: 3D-printed extravascular stenting of the left renal vein. From December 2017 to May 2019, 28 patients (25 men and 3 women) from different parts of China between 18 and 37 years old (mean, 23.6 years) diagnosed with NCS were admitted for laparoscopic 3D-printed extravascular stenting treatment. The post-operative follow-up duration was 6-24 months (median, 16.3 months). Technical success of the operation was achieved in all patients. After treatment, the NCS symptoms all patients resolved or improved during the follow-up period, without relapse. Most symptoms, including macro-/microhematuria, proteinuria, and flank/abdominal pain, tended to resolve within 3-6 months after the surgery; other symptoms, such as left-sided varicocele, also showed varying degrees of improvement at different times post-operatively. Perioperative complications were noted in two patients, including transient and mild lymphatic leakage, without any adverse effects. All extravascular stents were visualized on computed tomography and Doppler ultrasound scans, and no migration or any side effects occurred during the entire follow-up period. Compared to endovascular stenting or polytetrafluoroethylene artificial vessel procedures, 3Dprinted polyetheretherketone extravascular stenting has more advantages in terms of stent design and rigidity and approach rationality while successfully preventing stent migration and thrombosis. Therefore, this method may serve as an accurate and effective treatment for NCS patients.

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

“…The possibility of graft deformation, migration, and restenosis of the LRV still needs to be investigated. To solve these problems, our team proposed the technique of 3DP-EXVS to treat NCS ( 28 , 29 ).…”

3D printing of bone and cartilage with polymer materials

“…Polyetheretherketone has the advantages of radiation permeability and no artifacts in magnetic resonance scanning, which can better evaluate postoperative recovery ( Fairag et al, 2021 ; Han et al, 2022 ). It has been used in artificial joint jaws, skulls, and spines: lumbar spine, oral defect repair, and other fields ( He et al, 2020a ; Li et al, 2021a ; Li et al, 2022a ). Also, compared with traditional metal materials (stainless steel, titanium alloy) implanted into human body, polyetheretherketone has good biocompatibility, and its elastic modulus is comparable to human cortical bone ( He et al, 2020a ; Li et al, 2021a ).…”

“…It has been used in artificial joint jaws, skulls, and spines: lumbar spine, oral defect repair, and other fields ( He et al, 2020a ; Li et al, 2021a ; Li et al, 2022a ). Also, compared with traditional metal materials (stainless steel, titanium alloy) implanted into human body, polyetheretherketone has good biocompatibility, and its elastic modulus is comparable to human cortical bone ( He et al, 2020a ; Li et al, 2021a ). It can effectively reduce the stress shielding effect after implantation into the human body.…”

Laparoscopic placement of left renal vein extravascular stenting in treatment of nutcracker syndrome: Techniques and long‐term outcomes

“…Till date, a total of 15 studies have reported the clinical outcomes and complications of 100 patients using laparoscopic or robot‐assisted extravascular stent for NCS 5,7–20 . Of the enrolled patients, 98 (98%) had complete symptom resolution or significant symptom improvement, and 2 (2%) had no symptom improvement because of the extravascular stent migration during follow‐up 5,7–20 . However, due to small sample size (1–28 patients) and short follow‐up time, long‐term results remain largely unreported.…”