362 3D Printed PEEK Extravascular Stent in Treatment of Nutcracker Syndrome in an Adolescent Boy

A 14-year-old boy with constant and intense periumbilical pain for the past 24 months caused by nutcracker syndrome (NCS) (visual analog pain scale, 8-9) was treated with 3D printed PEEK extravascular stent. To our best knowledge this is the first European application in a child. 3D model reconstruction showed that the left renal vein (LRV) and the duodenum were contracted at almost the same level via aortomesenteric angle, resulting in LRV compression from the abnormal high-level duodenal compartment. Surgical procedure included a dissection of fibrous bundles which freed the duodenum. LRV was dissected out medially from the renal hilum to the vena cava inferior until it was completely mobilized. A complete resection off the narrow fibrous ring between abdominal aorta and superior mesenteric artery was necessary. 3D printed PEEK extravascular stent via camera port was placed and bound to the narrowed portion of LRV to prevent blood vessel compression. Such stent demonstrates significant advantages over open or other minimally invasive surgery such as endovascular stenting and artificial vessels procedures with expanded polytetrafluoroethylene. It has distinctive personalized design and good rigidity as well as durability which allow vascular growth, preventing stent migration and thrombosis as well. Therefore, it is suitable for both adult and pediatric patients.