Use of a newly designed multifunctional coil catheter for stent placement in the upper gastrointestinal tract

Fluoroscopy-Guided Peroral Placement of a Self-Expandable Metallic Stent for Malignant Jejunal Obstruction in a Non-surgically Altered Stomach

Malignant small bowel obstruction is a common and distressing complication in advanced cancer patients. Recently, stent placement was reported to be a safe and effective alternative treatment. However, there are only a few case reports associated with stent placement in malignant jejunal obstruction. Furthermore, most patients had a history of gastrectomy before stent placement, which shortens the catheterization pathway. In our case series, we present five cases of malignant proximal jejunal obstruction in a non-surgically altered stomach in the management of fluoroscopy-guided self-expandable metallic stent placement and discuss the interventional management and clinical outcomes. LEVEL OF EVIDENCE: Level 4, Case Series.

Fluoroscopic Gastroduodenal Stent Placement in 55 Patients with Endoscopic Stent Placement Failure

PURPOSE

To evaluate the technical feasibility and clinical effectiveness of fluoroscopic self-expandable metal stent (SEMS) placement in malignant gastroduodenal obstructions after failed endoscopic SEMS placement.

MATERIALS AND METHODS

Between September 2010 and July 2017, 874 patients underwent endoscopic SEMS placement for dysphagia caused by malignant gastroduodenal obstructions. Endoscopic SEMS placement failed in 55 of 874 patients (6.3%). These patients were referred for fluoroscopic SEMS placement. In case of failed fluoroscopic SEMS placement, combined endoscopic and fluoroscopic SEMS placement was attempted at the same setting.

RESULTS

Fluoroscopic SEMS placement was technically successful in 40 of 55 patients (72.7%). Combined endoscopic and fluoroscopic SEMS placement was technically successful in 6 of 15 patients with fluoroscopic SEMS placement failure. Failures in the nine patients were due to complete obstruction (n = 5) and acute angulation at the stricture site (n = 4). The overall technical success rate was 83.6% (46/55). Clinical success was achieved in 95.6% of patients (44/46). Complications occurred in 7 of 46 patients (15.2%), including tumor overgrowth (n = 3), SEMS migration (n = 3), and bleeding (n = 1). The median SEMS patency and patient survival periods were 515 (95% confidence interval (CI), 266.6-761.5) and 83 (95% CI 60.6-105.4) days, respectively.

CONCLUSIONS

Fluoroscopic SEMS placement is technically feasible and clinically effective in cases of endoscopic SEMS placement failure. A combined endoscopic and fluoroscopic approach increases the technical success rate after failure of the endoscopic or fluoroscopic approach.

LEVEL OF EVIDENCE

Level IV.

Fluoroscopic-guided stent placement in failed tentative endoscopic approaches to malignant gastroduodenal obstructions

Background Fluoroscopic or endoscopic placement of metallic stents is used as a safe, non-surgical, palliative treatment option for malignant gastroduodenal obstructions. However, endoscopic stent placement is not always feasible, due to the tight or tortuous stricture of the obstructed area and insufficient visualization of the stomach due to remnant food material. Purpose To assess the technical feasibility and clinical outcomes of fluoroscopic-guided stent placement in malignant gastroduodenal obstructions following the technical failure of endoscopic stent placement. Material and Methods In all, 19 patients (14 men, 5 women; age range, 36-85 years) were referred due to technical failures of tentative endoscopic stent placement. Indications were failure to pass the guide wire through the obstruction (n = 13), failure to reach the stricture lesion due to short endoscope (n = 5), and acute angulation of the stricture lesion (n = 1). Data were retrospectively collected regarding the technical and clinical success of the fluoroscopy, the dysphagia score before and after stent placement, and major complications and their management. Results Fluoroscopic stent placement was technically successful in 15/19 patients (79%). Failures were due to complete obstruction (n = 3) and acute angulation of the stricture lesion (n = 1). Clinical success was achieved in all 15 patients with successful stent placement. The dysphagia score significantly improved after stent placement ( P < 0.001). Complications occurred in 4/15 patients (27%), including tumor overgrowth (n = 2), stent collapse (n = 1), and jaundice (n = 1). Conclusion Fluoroscopic stent placement in malignant gastroduodenal obstructions following a technical failure of endoscopic stent placement is technically feasible and has an acceptable clinical outcome.

Overlapping self-expandable metallic stent for palliation of a long (>10 cm) malignant gastroduodenal obstruction

Background Self-expandable metallic stent (SEMS) placement is a well-established palliative treatment approach for malignant gastroduodenal obstruction. In patients with a long (>10 cm) stricture, multiple stents placed in an overlapping fashion are often required. Purpose To investigate the outcomes of overlapping SEMS placement for the palliative treatment of malignant gastroduodenal obstruction in patients with a long (>10 cm) stricture. Material and Methods The medical records of 40 patients who underwent fluoroscopic overlapping SEMS placement for malignant gastroduodenal obstruction due to a long (>10 cm) stricture were reviewed. Results The technical and clinical success rates were 100% and 65.0%, respectively. The mean length of the stricture was 17.0 ± 4.7 cm and the mean number of stents placed in each patient was 2.2 ± 0.5. Metastatic cancer (odds ratio [OR], 0.315; P = 0.018), Eastern Cooperative Oncology Group (ECOG) score ≥3 (OR, 0.018; P = 0.006), and carcinomatosis with ascites (OR, 0.025; P = 0.017) were independent predictors of poor clinical success. The rates of minor and major complications were 27.5% and 2.5%, respectively. The median stent patency and survival were 33 days (interquartile range [IQR], 19-60 days) and 35 days (IQR, 19-73 days), respectively. An ECOG score ≥3 was an independent predictor of a poor survival outcome (hazard ratio, 4.681; P < 0.001). Conclusion Overlapping SEMS placement may be safe and effective for the palliative treatment of malignant gastroduodenal obstruction in patients with a long (>10 cm) stricture.

A novel method of punctured Miller-Abbott tube placement using a guidewire under fluoroscopic guidance

OBJECTIVE

The purpose of this article is to evaluate the usefulness of a new technique for placing Miller-Abbott tubes in patients with small-bowel obstruction.

SUBJECTS AND METHODS

The Miller-Abbott tube was placed in 10 patients by use of the conventional method (group A) and in 11 patients with a punctured Miller-Abbott tube with the use of guidewire (group B). Technical success was defined as insertion of the tube into the duodenum beyond the pylorus of the stomach in group A and into the jejunum beyond the Treitz ligament in group B. Clinical success was defined as intestinal decompression and relief of obstructive symptoms. We evaluate the correlations between the cause of obstruction and the end results.

RESULTS

The success rate of the tube placement was 40% (4/10) in group A and 100% (11/11) in group B. Clinical success of tube placement was achieved in five of 10 patients (50.0%) in group A and in nine of 11 patients (81.8%) in group B. Carcinomatosis was associated with significantly decreased clinical success rates in both groups (p = 0.038 in group A; p = 0.039 in group B). The mean (± SD) procedure time for placement of the Miller-Abbott tube was 35.8 ± 8.13 minutes in group A and 15.3 ± 5.93 minutes in group B, with a statistically significant difference (p < 0.001).

CONCLUSION

The new technique of placing a punctured Miller-Abbott tube with the use of a guidewire enables the tube to pass through the pylorus and the Treitz ligament while significantly reducing the procedure time, with no clinical disadvantages caused by the puncture site.

The outcome of fluoroscopically guided balloon dilation of pyloric stricture in Crohn disease

PURPOSE

To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation for pyloric stricture associated with Crohn disease (CD) while monitoring the outcome.

MATERIALS AND METHODS

Five patients (age range 15-34 y) were diagnosed with symptomatic pyloric stricture associated with CD between November 2006 and August 2009. All five patients underwent fluoroscopically guided balloon dilation one or more times.

RESULTS

The initial balloon dilations were technically successful in all patients. Two patients showed improvement of symptoms without further need of dilation, two patients had one more session of dilation, and one patient underwent two more sessions of repeated dilation. There were no procedure-related complications. Overall technical and clinical success rates were 100%. After the last dilation, all patients remained healthy, with no case of relapse of obstructive symptoms during the median follow-up of 16 months (range 6-22 mo).

CONCLUSIONS

Fluoroscopically guided balloon dilation seems to be a useful tool for management of symptomatic pyloric stricture in CD and may be a viable alternative to open surgery.

Fluoroscopically guided balloon dilation for pharyngoesophageal stricture after radiation therapy in patients with head and neck cancer

OBJECTIVE

The purpose of this article is to assess the safety and long-term efficacy of fluoroscopically guided balloon dilation for pharyngoesophageal strictures after radiation therapy in patients with head and neck cancers.

MATERIALS AND METHODS

From April 1997 to February 2009, fluoroscopically guided balloon dilation was performed in 17 patients with pharyngoesophageal strictures caused by radiation therapy. Technical success, clinical success (decrease of at least one grade in dysphagia score and good contrast passage on 1-month follow-up esophagogram), recurrence of dysphagia, and complications related to the procedure were retrospectively evaluated.

RESULTS

All 17 patients underwent 41 balloon dilation procedures, with each patient undergoing one to seven procedures (mean, 2.4 procedures). The technical success rate was 100%, and clinical success was achieved in 64.7% (11/17) of the patients. Five patients (29.4%) showed no recurrence of dysphagia after one session of balloon dilation. Of 12 patients (70.6%) with recurrence of dysphagia, 10 underwent repeat balloon dilation and two underwent gastrostomy after the first session of balloon dilation. The maximum balloon diameters were 15 mm (n = 22), 20 mm (n = 16), and 25 mm (n = 3). As minor complications, three cases of type 1 esophageal rupture occurred in two patients (11.8%). There were no major complications.

CONCLUSION

Although the recurrence rate was high with repeat balloon dilation, fluoroscopically guided balloon dilation seems to be a simple and safe primary treatment technique for pharyngoesophageal stricture due to radiation therapy in patients with head and neck cancer.

Fluoroscopically guided percutaneous jejunostomy with use of a 21-gauge needle: a prospective study in 51 patients

PURPOSE

To assess the safety and clinical efficacy of fluoroscopically guided percutaneous jejunostomy with use of a 21-gauge needle and a single anchor technique in 51 patients.

MATERIALS AND METHODS

From November 2006 to January 2009, 51 consecutive patients (42 men and nine women; mean age, 63.7 years) underwent percutaneous jejunostomy under fluoroscopic guidance. A 7.5-F multifunctional coil catheter was used to insufflate the jejunum. The distended jejunum was punctured with a 21-gauge needle, with the inserted coil catheter as the target. A single anchor was used. The technical success, number of punctures, procedure time, complications, and follow-up data including 30-day mortality rate were evaluated.

RESULTS

The technical success rate was 100%, and the single anchor technique was used in all but one patient, in whom three anchors were used. The mean number of punctures was 1.7 (range, 1-4), and the mean procedure time was 14.8 minutes (range, 7-29 min). Peritonitis was a major complication in two patients (3.9%), who were treated by changing the catheters from 14 F to 16 F and performing percutaneous drainage procedures. Three minor complications were encountered: superficial cellulitis (n = 2) and severe puncture site pain (n = 1). The 30-day mortality rate was 5.9% (three of 51), although none of the deaths could be attributed to the jejunostomy procedures.

CONCLUSIONS

Fluoroscopically guided percutaneous jejunostomy with use of a 21-gauge needle and the single anchor technique seems to be safe and effective, with high technical success and low complication rates.

Metallic stent placement in patients with recurrent cancer after gastrojejunostomy

PURPOSE

To assess the technical feasibility and clinical effectiveness of placement of expandable metallic stents in patients with recurrent cancer after a gastrojejunostomy.

MATERIALS AND METHODS

Data from 39 consecutive patients who had undergone metallic stent placement for recurrent malignant obstruction after a gastrojejunostomy were retrospectively analyzed. Thirty patients underwent a distal gastrectomy with a gastrojejunostomy with (n=10) or without (n=20) jejunojejunostomy, two patients underwent distal gastrectomy with a Roux-en-Y gastrojejunostomy, and seven patients underwent a palliative gastrojejunostomy with (n=5) or without (n=2) jejunojejunostomy. A total of 57 metallic stents were used in this study: four bare stents, 29 partially covered stents, and 24 fully covered stents. Types of obstruction were classified into 12 patterns and types of stent placement were classified into 16 patterns.

RESULTS

Stent placement was technically successful in all patients. After stent placement, 35 of the 39 patients (90%) experienced improvement of their symptoms, two showed no change, and the remaining two showed aggravation of symptoms as a result of faulty stent placement. Two patients treated with stent placement only in the afferent loop died of aspiration pneumonia. In one of two patients who underwent stent placement according to pattern 6, afferent loop syndrome occurred 10 days after stent placement and was treated by percutaneous pigtail catheter drainage. Stent migration occurred in four of 24 fully covered stents, but in none of the bare or partially covered stents. Tumor ingrowth occurred in one of four bare stents, tumor overgrowth in one of 29 partially covered stents, and mucosal prolapse in one of 24 fully covered stents; all were treated with a second stent placement.

CONCLUSIONS

Placement of expandable metallic stents in patients with recurrent cancer after a gastrojejunostomy seems to be feasible and effective, but accurate knowledge of the type of surgical procedure performed and determination of the pattern of tumor recurrence are important for successful stent placement.

Treatment of gastric outlet and duodenal obstructions with uncovered expandable metal stents

AIM: To investigate and evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided peroral uncovered expandable metal stent placement to treat gastric outlet and duodenal obstructions.

METHODS: Fifteen consecutive patients underwent peroral placement of Wallstent^TM Enteral Endoprosthesis to treat gastric outlet and duodenal obstructions (14 malignant, 1 benign). All procedures were completed under fluoroscopic guidance without endoscopic assistance. Follow-up was completed until the patients died or were lost, and the clinical outcomes were analyzed.

RESULTS: The technique success rate was 100%, and the oral intake was maintained in 12 of 14 patients varying from 7 d to 270 d. Two patients remained unable to resume oral intake, although their stents were proven to be patent with the barium study. One patient with acute necrotizing pancreatitis underwent enteral stenting to treat intestinal obstruction, and nausea and vomiting disappeared. Ten patients died during the follow-up period, and their mean oral intake time was 50 d. No procedure-related complications occurred. Stent migration to the gastric antrum occurred in one patient 1 year after the procedure, a tumor grew at the proximal end of the stent in another patient 38 d post-stent insertion.

CONCLUSION: Fluoroscopically guided peroral metal stent implantation is a safe and effective method to treat malignant gastrointestinal obstructions, and complications can be ignored based on our short-term study. Indications for this procedure should be discreetly considered because a few patients may not benefit from gastrointestinal insertion, but some benign gastrointestinal obstructions can be treated using this procedure.

Fluoroscopically guided percutaneous jejunostomy: outcomes in 25 consecutive patients

AIM

To assess the feasibility and safety of fluoroscopically guided percutaneous jejunostomy.

MATERIAL AND METHODS

Between May 1999 and August 2006 percutaneous jejunostomy was attempted in 25 patients. A 5 F vascular catheter (n=20) or a 7.5 F multifunctional coil catheter (n=5) was used to insufflate the jejunum. The distended jejunum was punctured using a 17 G needle (n=19) or a 21 G Chiba needle (n=6) with the inserted catheter as a target. A 12 or 14 F loop feeding tube was inserted after serial dilations. The technical success, complications, 30-day mortality, and in-dwelling period of the feeding tube placement were evaluated.

RESULTS

The technical success rate was 92% (23/25). Technical failures (n=2) resulted from the inability to insufflate the jejunum secondary to failure to pass the catheter through a malignant stricture at the oesophagojejunostomy site and thus subsequent puncture of the undistended jejunum failed, or failure to introduce the Neff catheter into the jejunum. Pericatheter leakage with pneumoperitoneum was a complication in three patients (12%) and was treated conservatively. The 30-day mortality was 13% (3/23); however, there was no evidence that these deaths were attributed to the procedure. Except for four patients who were lost to follow-up and two failed cases, 15 of the 19 jejunostomy catheters were removed because of patient death (n=12) or completion of treatment (n=3), with a mean and median in-dwelling period of 231 and 87 days, respectively.

CONCLUSIONS

Fluoroscopically guided percutaneous jejunostomy is a feasible procedure with a high technical success and a low complication rate. In addition to a 17 G needle, a 21 G needle can safely be used to puncture the jejunum.

Fluoroscopically Guided Balloon Dilation of Anastomotic Strictures After Total Gastrectomy: Long-Term Results

OBJECTIVE

The purpose of this study was to evaluate the radiologic and clinical effectiveness and long-term results of fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy.

CONCLUSION

Fluoroscopically guided balloon dilation is effective and safe and has encouraging long-term results in the management of benign anastomotic strictures after total gastrectomy.

Malignant duodenal obstructions: palliative treatment using self-expandable nitinol stents

PURPOSE

To assess the efficacy of fluoroscopic per oral placement of self-expandable nitinol stents in the palliative treatment of malignant duodenal obstructions.

MATERIALS AND METHODS

Under fluoroscopic guidance, 82 patients (56 male and 26 female; mean age, 62.3 y) with malignant duodenal obstructions were treated with per oral placement of four types of self-expandable nitinol stents. All patients presented with severe nausea and recurrent vomiting, and their obstructions were inoperable.

RESULTS

Technical success was achieved in 78 of 82 patients (95.1%). After stent placement, food intake capacity improved in 74 of 78 patients (94.9%). Stent migration occurred in one patient 4 days after placement. A covered stent was placed to cover the ampulla of Vater in 15 patients without external biliary drainage; three of them (20%) became jaundiced. During the mean follow-up period of 74.7 days (range, 9-374 d), eight patients developed recurrent obstructive symptoms caused by tumor ingrowth (n=2) or tumor overgrowth (n=6). They were successfully treated by additional stent placement. The primary stent patency rates were 97.0%, 79.8%, and 44.0% at 30-, 90-, and 180 days, respectively (mean patency, 228.2 d; 95% CI, 153.9-302.5).

CONCLUSIONS

Fluoroscopic per oral placement of self-expandable nitinol stents is an effective palliative treatment for malignant duodenal obstructions.

Balloon sheaths for gastrointestinal guidance and access: a preliminary phantom study

Objective

We wanted to evaluate the feasibility and usefulness of a newly designed balloon sheath for gastrointestinal guidance and access by conducting a phantom study.

Materials and Methods

The newly designed balloon sheath consisted of an introducer sheath and a supporting balloon. A coil catheter was advanced over a guide wire into two gastroduodenal phantoms (one was with stricture and one was without stricture); group I was without a balloon sheath, group ll was with a deflated balloon sheath, and groups III and IV were with an inflated balloon and with the balloon in the fundus and body, respectively. Each test was performed for 2 minutes and it was repeated 10 times in each group by two researchers, and the positions reached by the catheter tip were recorded.

Results

Both researchers had better performances with both phantoms in order of group IV, III, II and I. In group IV, both researchers advanced the catheter tip through the fourth duodenal segment in both the phantoms. In group I, however, the catheter tip never reached the third duodenal segment in both the phantoms by both the researchers. The numeric values for the four study groups were significantly different for both the phantoms (p < 0.001). A significant difference was also found between group III and IV for both phantoms (p < 0.001).

Conclusion

The balloon sheath seems to be feasible for clinical use, and it has good clinical potential for gastrointestinal guidance and access, particularly when the inflated balloon is placed in the gastric body.

Gastric outlet obstruction caused by benign anastomotic stricture: treatment by fluoroscopically guided balloon dilation

PURPOSE

To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation of gastric outlet obstruction caused by benign anastomotic stricture.

MATERIALS AND METHODS

Fluoroscopically guided balloon dilation was performed on 17 patients with gastric outlet obstruction caused by benign anastomotic stricture. Fourteen patients underwent surgery for malignant disease and three patients for complication of benign gastric ulcer. The sites of anastomotic stricture were gastrojejunal (n = 12) or gastroduodenal (n = 5). An upper gastrointestinal (UGI) series was performed just following and 1 month after balloon dilation to evaluate both the clinical success of the procedure and any complications. A dietary intake was evaluated by using the score for patients with malignant dysphagia and the pre- and postballoon dilation scores were analyzed with the Wilcoxon signed rank test.

RESULTS

In all patients, fluoroscopically guided balloon dilation was performed in one (n = 15) or two (n = 2) sessions and was technically and clinically successful (100%). The diameters of the balloon catheters used were 15 mm (n = 4), 20 mm (n = 14), and 25 mm (n = 1 mm; mean, 19.5 mm) in a total of 19 sessions. All patients had significant improvement of their levels of dietary intake (P < .001). Two of the 17 patients required the second procedure due to recurrent symptom nine and 15 months, respectively, after initial balloon dilation. Overall, 16 patients (94%) showed good results and no recurrence during a mean follow-up period of 13.5 months (range, 5-39 months). There were no major complications associated with balloon dilation.

CONCLUSION

Fluoroscopically guided balloon dilation seems to be effective and safe for patients with gastric outlet obstruction caused by benign anastomotic stricture. Achieving a luminal diameter of 20 mm seems to be necessary to prevent recurrence of symptoms.

Benign duodenal strictures: treatment by means of fluoroscopically guided balloon dilation

Fluoroscopically guided balloon (15 or 20 mm in diameter) dilation was performed on eight patients with benign duodenal strictures caused by peptic ulcers (n = 6), Crohn's disease (n = 1), and postoperative adhesion (n = 1). The procedure was technically and clinically successful without complications in seven of the eight patients (88%). Duodenal perforation occurred immediately after 20-mm-diameter balloon dilation in one patient who underwent emergency surgery. During the mean follow-up of 30 months (range, 2-103 months), there was recurrence in two of the seven patients (29%) who then underwent surgery. The other five patients (71%) showed good results with no recurrence.

A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures

PURPOSE

To investigate the technical feasibility and clinical effectiveness of a dual expandable nitinol stent in the palliative treatment of malignant gastroduodenal strictures.

MATERIALS AND METHODS

The dual stent consisted of two stents, an outer partially covered stent and an inner bare nitinol stent. The outer diameter of the stent delivery system was 3.8 mm. With fluoroscopic guidance, the outer stent was placed into the stricture, followed by coaxial placement of the inner stent. The stent placement was attempted in 102 consecutive patients with malignant gastroduodenal strictures. The underlying causes of malignant strictures were gastric cancer (n = 55), pancreatic cancer (n = 24), gallbladder cancer (n = 7), cholangiocarcinoma (n = 5), duodenal cancer (n = 5), and metastatic cancer (n = 6). All patients presented with symptoms of gastric outlet obstruction.

RESULTS

Stent placement was technically successful and well tolerated in 101 of 102 patients (99%). After stent placement, 85 of the 101 patients (84%) with technical success experienced improvement of their symptoms. Tumor overgrowth occurred in five patients, stent migration in two, mucosal hyperplasia in one, bleeding in one, and jaundice in two. Seventy one of the 101 patients died 5 to 340 days (mean, 71 days) after stent placement from progression of their disease, myocardial infarction, bleeding, or sepsis. The remaining 30 patients are still alive 6 to 227 days (mean, 39 days) after stent placement. The 30-day, 60-day, 90-day, and 180-day survival rates were 78%, 58%, 39%, and 8%, respectively.

CONCLUSION

The dual stent with a 3.8-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant gastroduodenal strictures.

Use of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement

Our purpose was to assess the safety and usefulness of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement. Two types of guiding sheath were made from straight polytetrafluoroethylene tubes. Type A was 80 cm in length, 4 mm in outer diameter and 3 mm in inner diameter. Type B was 70 cm in length, 6 mm in outer diameter and 5 mm in inner diameter. The type A sheath was used in 18 patients in whom a catheter-guide wire combination failed to pass through a stricture. The type B sheath was used in 22 patients in whom a stent delivery system failed to pass through the stricture due to loop formation within the gastric lumen. The overall success rate for guiding a catheter-guide wire through a stricture after using the type A sheath was 89%. The overall success rate for passing a stent delivery system through a stricture after using the type B sheath was 100%. All procedures were tolerated by the patients without any significant complications. The guiding sheaths were safe and useful in peroral fluoroscopic gastroduodenal stent placement.

Computational Studies of Shape Memory Alloy Behavior in Biomedical Applications

Background: Nowadays, shape memory alloys (SMAs) and in particular Ni–Ti alloys are commonly used in bioengineering applications as they join important qualities as resistance to corrosion, biocompatibility, fatigue resistance, MR compatibility, kink resistance with two unique thermo-mechanical behaviors: the shape memory effect and the pseudoelastic effect. They allow Ni–Ti devices to undergo large mechanically induced deformations and then to recover the original shape by thermal loading or simply by mechanical unloading. Method of approach: A numerical model is developed to catch the most significant SMA macroscopic thermo-mechanical properties and is implemented into a commercial finite element code to simulate the behavior of biomedical devices. Results: The comparison between experimental and numerical response of an intravascular coronary stent allows to verify the model suitability to describe pseudo-elasticity. The numerical study of a spinal vertebrae spacer, where the effects of different geometries and material characteristic temperatures are investigated, allows to verify the model suitability to describe shape memory effect. Conclusion: the results presented show the importance of computational studies in designing and optimizing new biomedical devices.