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Three-dimensional (3D) printing was first described in the early 1980s. This manufacturing process is unique because an object is built up layer by layer rather than being cut from a larger block of material, as is done using subtractive manufacturing techniques like machining. This technology enables building accurate patient-specific 3D printed anatomic models that can be used for new surgical instrument development, physical measurements, diagnosis, surgical planning, and presentation to patients. This study is to apply 3D printing technique in the individualized planning of endovascular repair for aortic pathology including aortic dissection (AD) and abdominal aortic aneurysm (AAA).
Four cases were recruited in this study, including two cases of acute type B AD with an involvement of distal arch, one retrograde type A AD with a primary entry tear located in descending aorta, and one infrarenal AAA with complex neck anatomy. The 3D printing models were attempted using data from patient’s computed tomography scan, special software, and a 3D printing device. Morphological details were analyzed through 3D printing models and individualized planning of endovascular repair was made accordingly.
According to 3D printing model, endovascular repair with physician-modified fenestrated endograft (including fenestration for left subclavian artery and left common carotid artery in one case and fenestration for the left common carotid artery in the other one) was done in two type B AD patients. Endovascular stenting in descending aorta instead of open surgery was applied in the retrograde type A AD patient. A full-sized 3D printing replica model demonstrated the feasibility of endovascular repair in the infrarenal AAA patient with a short neck, though the extremely tortuous AAA had a sharp angulation of 90° with the normal abdominal aorta and right iliac artery respectively. In all cases, intra-operative angiography and postoperative follow-up showed no endoleak and preservation of neck blood flow with fenestration. All patients lived well and were free from aortic diseases during the follow-up period.
For complex aortic pathology, 3D printing helps individualized planning of endovascular repair in the following ways; (1) it helps to determine its feasibility before the operation; (2) it helps to choose correct devices; (3) it helps to make an accurate size of fenestration according to 3D measurement. However further large-scale studies are required to verify its long-term efficacy.