Retroperitoneal Laparoscopic Extravascular Stent Placement for Renal Nutcracker Syndrome: Initial Experience

Li, Pu; Shao, Pengfei; Qin, Chao; Ju, Xingrong; Meng, Xia; Li, Jie; Lv, Qiang; Cao, Qiang; Chen, Yin

doi:10.1159/000353349

Cited by 12 publications

(10 citation statements)

References 14 publications

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“…Although the outcomes of EVS treatment are encouraging, it is not a permanent solution for NCS, and for this reason, safer and more logical and effective surgical procedures may provide better outcomes. In recent decades, ePTFE artificial vessels have been used as extravascular stents for NCS because they involve minimal trauma, few complications, and a simple operation (Zhang et al, 2010;Li et al, 2014;Wang et al, 2015;Sorokin et al, 2018;Chen et al, 2019). Barnes et al (1988) performed the first ePTFE graft placement via an open approach in 1988.…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, ePTFE artificial vessels have been used as extravascular stents for NCS because they involve minimal trauma, few complications, and a simple operation ( Zhang et al, 2010 ; Li et al, 2014 ; Wang et al, 2015 ; Sorokin et al, 2018 ; Chen et al, 2019 ). Barnes et al (1988) performed the first ePTFE graft placement via an open approach in 1988.…”

Section: Discussionmentioning

confidence: 99%

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

Da-li

Liang

Wang

et al. 2020

Front. Bioeng. Biotechnol.

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Da-li

Liang

Wang

et al. 2020

Front. Bioeng. Biotechnol.

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“…One may postulate that externally suturing stent could be a way to keep it in place; therefore, Barnes firstly reported extravascular stenting and externally suturing the stent performed by open surgery in 1988 [ 12 ]. Currently, sporadic cases of extravascular stenting for the NCS have been reported with excellent outcome at short-term follow up [ 13 – 17 ]. The stent has good conformability to adapt to the vessel wall and adhere to the vessel wall tightly [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome

et al. 2015

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BackgroundNutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or embolization.Case presentationA 30-year-old female was diagnosed with nutcracker syndrome for severe left flank pain. After failed conservative approach, she underwent endovascular stenting and subsequently developed recurrent symptom for stent migration one month postoperatively. She underwent successful extravascular stenting with complete symptom resolution.ConclusionThe extravascular stenting is an alternative option after migration of left renal vein endovascular stenting. The computed tomographic imaging was closely correlated to therapeutic interventions and stent migration.

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“…Several surgical approaches have been previously described (graft vein interposition, transposition of the LRV, nephropexy, stenting, renocaval reimplantation, and renal autotransplantation) [8,9,10,11]. However, these surgical approaches are invasive and are not established as the gold standard.…”

Section: Discussionmentioning

confidence: 99%

Anterior Nutcracker Syndrome with Left Gonadal Vein Varicosities on Multiphasic Computed Tomography: An Unexpected Cause of Pyeloureteral Junction Obstruction

Carlo

Gaudiano²,

Busato³

et al. 2015

Urol Int

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The anterior nutcracker syndrome is defined by the compression of the left renal vein between the aorta and superior mesenteric artery, usually related to the occurrence of hematuria. We report the case of an uncommon complication of the nutcracker syndrome. A 75-year-old woman was referred to our institution for left flank pain without hematuria. Multiphasic computer tomography urography showed a condition of left renal vein entrapment between the aorta and superior mesenteric artery with the development of left gonadal vein varicosities at the level of the renal hilum; a pyeloureteral junction compression with dilation of the pyelocalyceal system coexisted. To our knowledge, this is the first report of the association between nutcracker syndrome and pyeloureteral junction obstruction.

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Retroperitoneal Laparoscopic Extravascular Stent Placement for Renal Nutcracker Syndrome: Initial Experience

Cited by 12 publications

References 14 publications

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

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

Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome

Anterior Nutcracker Syndrome with Left Gonadal Vein Varicosities on Multiphasic Computed Tomography: An Unexpected Cause of Pyeloureteral Junction Obstruction

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