हृदय रोग एवं निदान

In House Enhanced 3D Printing of Complex AAA for EVAR Treatment Planning and Preoperative Simulation

Abstract

Hoffman Aaron, Nitecki Samy, Engel Ahuva, Karram Tony, Leiderman Maxim Kogan Igor, Si-On Erez and Ofer Amos

Three dimensional printing (3D printing) is becoming a common useful technology in many areas in medicine. This technology allows better appreciation of complex anatomical and pathologic conditions. In vascular medicine and surgery 3d modeling may become of help in Endovascular Aortic Repair (EVAR) treatment planning, especially in cases of complex angulations and branching at the aneurysm neck. Accurate and rapid solid 3d models were prepared in house using common and freely available software programs, and an accurate 3D printer. These solid models allowed palpation and manual handling and visual inspection for a better appreciation of complex AAA necks. Color enhancement of these models added another dimension of comprehension, even for experienced surgeons and invasive radiologists. A full sized model may allow more accurate measurements of branch distances and angles in space when tortuosity is severe. Fenestrations and “Chimney” branches may be easily envisioned preoperatively. In addition, 3D hollow outer shells were constructed to obtain a workable AAA arterial wall-like model for rehearsal and preoperative stent graft deployment simulation. Various commercial stent grafts from several manufacturers were deployed under fluoroscopy to evaluate feasibility of the planned procedure. In simple AAA cases device deployment simulation was always successful, but in one AAA case with a severely angulated neck all devices failed. We conclude that 3D printing and modeling and outer shell fabrication for preoperative simulation are helpful in EVAR planning of complex AAA.