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Manzano JP, de Pinho JHS, de Oliveira Azambuja T, Ambrogini C, Bruna PC. Robot-assisted extravascular stent for nutcracker syndrome: A case report. Urol Case Rep 2022; 46:102311. [PMID: 36606097 PMCID: PMC9807993 DOI: 10.1016/j.eucr.2022.102311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/26/2022] Open
Abstract
Nutcracker syndrome (NCS) is a rare condition caused by compression of the left renal vein (LRV) between the aorta and superior mesenteric artery. Surgical treatment is reserved for patients with severe symptoms and failure of conservative treatment. A 31-year-old woman diagnosed in adolescence with NCS has had recurrent pain since age 15. For 30 days, she has had severe left flank pain and microhematuria. The patient underwent extravascular stent placement around the LRV with the Da Vinci Xi. In 30 months of follow-up, the patient has no pain and the LRV remained without compressions or thrombosis.
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Affiliation(s)
- João Pádua Manzano
- Federal University of São Paulo, São Paulo, Brazil,Brazilian Institute of Robotic Surgery, Moriah Hospital, São Paulo, Brazil
| | | | | | - Claudio Ambrogini
- Brazilian Institute of Robotic Surgery, Moriah Hospital, São Paulo, Brazil
| | - Paulo Collet Bruna
- Brazilian Institute of Robotic Surgery, Moriah Hospital, São Paulo, Brazil
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Chu T, Li Q, Dai C, Li X, Kong X, Fan Y, Yin H, Ge J. A novel Nanocellulose-Gelatin-AS-IV external stent resists EndMT by activating autophagy to prevent restenosis of grafts. Bioact Mater 2022; 22:466-481. [PMID: 36330163 PMCID: PMC9615139 DOI: 10.1016/j.bioactmat.2022.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
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. The NC-Gelatin extravascular stent has suitable physicochemical properties to prevent restenosis of the grafted veins. The NC-Gelatin extravascular stent has excellent biocompatibility, which is critical for grafting veins. The NC-Gelatin extravascular stent prevents restenosis by activating autophagy against EndMT. AS-IV can enhance the effect of the stent to activate autophagy against EndMT.
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Affiliation(s)
- Tianshu Chu
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Qingye Li
- College of Food Science, Sichuan Agricultural University, No.46, Xin Kang Road, Yaan, Sichuan Province, 625014, PR China
| | - Chun Dai
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Xiang Li
- CAS Key Laboratory of Soft Matter Chemistry, Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui, 230026, China
| | - Xiang Kong
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Yangming Fan
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Hongyan Yin
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jianjun Ge
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China,Corresponding author. The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China.
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Sorokin I, Nelson J, Rectenwald JE, Cadeddu JA. Robot-assisted laparoscopic extravascular stent for nutcracker syndrome. J Robot Surg 2017; 12:561-565. [PMID: 28861712 DOI: 10.1007/s11701-017-0744-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/27/2017] [Indexed: 11/25/2022]
Abstract
Minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Endovascular stenting has shown promising long-term resolution of symptoms but can be complicated by stent migration or thrombosis. Laparoscopic extravascular stent placement has shown promising results with the potential to avoid these complications. We report the first case of extravascular stent placement using the robotic approach for the treatment of nutcracker syndrome.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Jessica Nelson
- Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - John E Rectenwald
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey A Cadeddu
- Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
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