Multon Sébastien, Jayet Jérémie, Coscas Raphaël, Javerliat Isabelle, Coggia Marc
Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France.
UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France.
EJVES Vasc Forum. 2021 Nov 16;54:44-48. doi: 10.1016/j.ejvsvf.2021.11.001. eCollection 2022.
Left renal vein stenting (LRVS) for the treatment of anterior nutcracker syndrome (NCS) has been associated with a significant risk of stent migration into the inferior vena cava or right ventricle.
A hybrid technique is reported for the treatment of NCS to prevent stent migration. The first part of the procedure consists of LRVS at the level of the aortomesenteric compression. The second part consists of laparoscopic stent exofixation through a transperitoneal direct approach. The left renal vein is exposed in order to visualise the stent meshes through the venous wall. Stent exofixation in performed with a simple transfixing polypropylene stitch, reinforced with a Teflon pledget.
The hybrid treatment of anterior NCS combining laparoscopic stent exofixation with left renal vein stenting is a simple and low morbidity technique. Further follow up data are needed to evaluate its potential benefit in reducing the risk of left renal vein stent migration.
左肾静脉支架置入术（LRVS）用于治疗胡桃夹综合征（NCS）时，存在支架迁移至下腔静脉或右心室的重大风险。
报道了一种用于治疗NCS以防止支架迁移的联合技术。手术的第一部分包括在主动脉肠系膜压迫水平进行LRVS。第二部分包括通过经腹直接入路进行腹腔镜支架外固定。暴露左肾静脉以便透过静脉壁观察支架网孔。使用简单的贯穿聚丙烯缝线并辅以聚四氟乙烯小垫进行支架外固定。
将腹腔镜支架外固定与左肾静脉支架置入术相结合的NCS联合治疗是一种简单且发病率低的技术。需要进一步的随访数据来评估其在降低左肾静脉支架迁移风险方面的潜在益处。
