Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (E...Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.展开更多
To the Editor:Posterior nutcracker syndrome (PNS)is a condition caused by compression of the left renal vein (LRV)between the vertebral column and the aorta (AO).Open surgery with LRV transposition has usually been re...To the Editor:Posterior nutcracker syndrome (PNS)is a condition caused by compression of the left renal vein (LRV)between the vertebral column and the aorta (AO).Open surgery with LRV transposition has usually been recommended for patients with PNS.[1,4]However,existing surgical means of treatment are not sufficiently safe,effective,or minimally invasive.Here,we present one case of PNS treated with three-dimensional (3D)printed extravascular stent placement using laparoscopy.展开更多
Vein grafts are widely used for coronary artery bypass grafting and hemodialysis access,but restenosis remains the"Achilles’heel"of these treatments.An extravascular stent is one wrapped around the vein gra...Vein grafts are widely used for coronary artery bypass grafting and hemodialysis access,but restenosis remains the"Achilles’heel"of these treatments.An extravascular stent is one wrapped around the vein graft and provides mechanical strength;it can buffer high arterial pressure and secondary vascular dilation of the vein to prevent restenosis.In this study,we developed a novel Nanocellulose-gelatin hydrogel,loaded with the drug Astragaloside IV(AS-IV)as an extravascular scaffold to investigate its ability to reduce restenosis.We found that the excellent physical and chemical properties of the drug AS-IV loaded Nanocellulose-gelatin hydrogel external stent limit graft vein expansion and make the stent biocompatible.We also found it can prevent restenosis by resisting endothelial-to-mesenchymal transition(EndMT)in vitro.It does so by activating autophagy,and AS-IV can enhance this effect both in vivo and in vitro.This study has added to existing research on the mechanism of extravascular stents in preventing restenosis of grafted veins.Furthermore,we have developed a novel extravascular stent for the prevention and treatment of restenosis.This will help optimize the clinical treatment plan of external stents and improve the prognosis in patients with vein grafts.展开更多
文摘Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.
文摘To the Editor:Posterior nutcracker syndrome (PNS)is a condition caused by compression of the left renal vein (LRV)between the vertebral column and the aorta (AO).Open surgery with LRV transposition has usually been recommended for patients with PNS.[1,4]However,existing surgical means of treatment are not sufficiently safe,effective,or minimally invasive.Here,we present one case of PNS treated with three-dimensional (3D)printed extravascular stent placement using laparoscopy.
基金This work gained supports by the Natural Science Foundation of Anhui Province(Grant No.2008085MH240)the Major Science and Technology Project of Anhui Province(Grant No.18030801132)the R&D projects for medical and health institutions of Hefei(Grant No.2021YL002).
文摘Vein grafts are widely used for coronary artery bypass grafting and hemodialysis access,but restenosis remains the"Achilles’heel"of these treatments.An extravascular stent is one wrapped around the vein graft and provides mechanical strength;it can buffer high arterial pressure and secondary vascular dilation of the vein to prevent restenosis.In this study,we developed a novel Nanocellulose-gelatin hydrogel,loaded with the drug Astragaloside IV(AS-IV)as an extravascular scaffold to investigate its ability to reduce restenosis.We found that the excellent physical and chemical properties of the drug AS-IV loaded Nanocellulose-gelatin hydrogel external stent limit graft vein expansion and make the stent biocompatible.We also found it can prevent restenosis by resisting endothelial-to-mesenchymal transition(EndMT)in vitro.It does so by activating autophagy,and AS-IV can enhance this effect both in vivo and in vitro.This study has added to existing research on the mechanism of extravascular stents in preventing restenosis of grafted veins.Furthermore,we have developed a novel extravascular stent for the prevention and treatment of restenosis.This will help optimize the clinical treatment plan of external stents and improve the prognosis in patients with vein grafts.
