The Use of Modified 3D-Printed Models for Precise Fenestrations in Physician-Modified Endografts to Treat Aortic Dissections Involving Visceral Branches.

Abstract

Purpose: This study aims to summarize the experience and outcomes of using 3D printing technology to assist physician-modified fenestrated-branched endovascular aortic repair (PM-FBEVAR) in the treatment of thoracoabdominal aortic dissection involving visceral branches.

Materials and methods: From December 2018 to May 2023, clinical data of 48 consecutive patients (35 males; mean age, 62.9±11.57 years) from 3 hospitals with thoracoabdominal aortic dissection involving visceral branches were retrospectively analyzed. All patients underwent PM-FBEVAR assisted by modified 3D-printed models. The modified 3D-printed models were designed according to estimated aortic morphology after physician-modified endografts were implanted. These models were fabricated using polycaprolactone composite photosensitive resin and stereolithography technology. They were utilized for preoperative planning and guiding the modification of stent grafts to assist in the positioning of the fenestrations. Outcomes including technical success, 30-day mortality, major adverse events (paraplegia, respiratory failure, major stroke, myocardial infarction, acute kidney injury, bowel ischemia, and lower limb ischemia), target vessel-related outcomes (branch occlusion or stenosis, target vessel instability, endoleak), reintervention, and survival were analyzed. Follow-up was completed in all patients.

Results: Technical success was achieved in 44 of 48 (91.67%) in patients and 178 of 182 (97.8%) in target vessels. The average operation time was 371.94±63.47 minutes, including a mean of 54.69±9.42 minutes for endograft customization and a mean of 211.92±55.44 minutes for endovascular operation. Perioperative major adverse events include 3 cases (6.25%) of acute renal injury and 1 case (2.08%) of transient paraplegia with no permanent neurological symptoms. The median follow-up was 24 (interquartile range, 12-30) months, and mortality was 0%. Seven endoleaks were detected during follow-up. One type Ic endoleak was managed with a reintervention procedure. One type IIIc endoleak spontaneously disappeared and the other type IIIc endoleak reduced. All 4 type II endoleaks remained stable during follow-up.

Conclusion: Rapid and accurate intraoperative fenestrations were achieved with the assistance of 3D printing for thoracoabdominal aortic dissection involving visceral branches. The modified 3D printing assisted PM-FBEVAR appears to be a safe and promising treatment option during early and mid-term follow-up.

Clinical impact: This study highlights the use of modified 3D printed models to enhance the precision of fenestrations in physician-modified endografts for treating thoracoabdominal aortic dissection involving visceral branches. The innovation lies in creating patient-specific 3D models based on pre- and post-implantation anatomy, allowing clinicians to optimize fenestration positioning. This approach has the potential to reduce procedural complexity and improve accuracy, leading to better clinical outcomes. For clinicians, it offers a valuable tool for preoperative planning and intraoperative guidance, potentially streamlining the treatment of complex aortic dissections.