Abstract
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.
Highlights
Planning of treatment for patients with Abdominal Aortic Aneurysms (AAA) requires detailed preoperative knowledge of anatomical details, especially if Endovascular Aneurysm Repair (EVAR) is contemplated
The tactile and visual inspection of a complex AAA model is helpful in better comprehending all minute details of the disease to improve treatment plans
Many aspects of the preoperative evaluation of a complex AAA may change due to new observations on a solid model
Summary
Planning of treatment for patients with Abdominal Aortic Aneurysms (AAA) requires detailed preoperative knowledge of anatomical details, especially if Endovascular Aneurysm Repair (EVAR) is contemplated. A mistake in preoperative evaluation may lead to angular misalignment of the stent graft with the aortic wall, insufficient length of overlap, endoleaks, migration, limb occlusions, ruptures, or visceral malperfusion [1]. Dedicated software packages are available for automatic recognition and naming of each artery and branch and for stent planning . These methods proved to be accurate and they allow the surgeon and the invasive radiologists excellent precision of planning in most AAA cases. In some cases of complex AAA, especially with short necks, severe juxta renal tortuosity and angulation, and proximity of visceral branches, the real dimensions are very difficult to comprehend even by experienced surgeons. It was felt that for those selected difficult cases better methods should be explored
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