369 A successful resolution of nutcracker syndrome with 3D printed PEEK extravascular stent in an adolescent boy

Abstract

<h3></h3> Three-dimensional printed 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 with reduced contrast filling immediately before its inflow into 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 left renal vein compression from the abnormal high-level duodenal compartment. When duodenum coarses between the abdominal aorta and superior mesenteric artery (duodenal interposition), the left renal vein entrapment occurs even at &lt; 90 aortomesenteric degrees. Three-dimensional PEEK printed extravascular stent was chosen to elevate the superior mesenteric artery and lower the duodenum position, thus relieving left renal vein 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 MSCT scan, the post-operative follow-up results are satisfactory one year after surgery. The patient feels well, the blood flow in the left renal vein is not obstructed, and the blood flow velocity was average. The external stent is in place.