Abstract No. 455 Customized patient-specific three-dimensional printed pediatric renovascular phantom for complex renal artery stenosis preprocedural planning: “plug and play”

Abstract

The renal artery ostial anatomy, balloon profile and stent deployment are all elements of complex procedural RAS planning in children. This study aims to establish the feasibility of performing simulated renovascular intervention on a 3D printed pediatric RAS endovascular phantom. The first iteration of this phantom contained a normal nonremovable renovascular system. This iteration is upgraded to a removable patient tailored specific RAS “plug and play” module facilitating pre procedure planning. Silicone poured in 3D printed molds were created from the patient’s CT. An additional upper extremity vascular access point was added and a pump was installed to simulate circulatory flow. Models: patient- specific left inferior branch high-grade RAS (80%) and bilateral RAS (63% and 45%) with steep ostial angle Simulation steps: catheter and balloon entry via upper and lower extremity, selective renal angiography, stenosis identification and transgression, cutting balloon angioplasty and balloon expandable stent simulation. Operators completed a 10 point questionnaire, rating their experience using a 5-point Likert scale (1-Strongly disagree to 5-Strongly agree). Upper extremity approach was deemed necessary for selective renal catheterization due to the steep renal artery ostial angulation. Case 1: Left proximal RAS stenting was performed using 5 x 8 mm and 5 x 15 mm Viabahn balloon-expandable stents. Case 2: Right RAS (45%) 3x10 mm cutting balloon angioplasty followed by placement of a 3 x 8 mm balloon-expandable stent. Significant angiographic improvement was noted post procedure in both cases. Three operators had good agreement (k = 0.46) that the 3D printed phantom is helpful in procedure planning, skill development and provides a realistic experience from catheterization to stenting. The simulation resulted in a planned live patient brachial access. To our knowledge this is the first pediatric renovascular phantom using a patient-specific removable model. This platform can provide patient focused simulation for renal arterial approach, balloon stricture negotiation, stent sizing and deployment, all complex elements of this procedure in children.