Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease
Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease
复制标题
使用 3D 打印指导医生改良的覆膜支架开窗，用于治疗胸腹主动脉疾病
DOI：
10.1177/1526602820917960
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发表时间：
2020-06-01
影响因子：
2.6
通讯作者：
Liu, Zhao
中科院分区：
文献类型：
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作者：
Tong, Yuan-Hao;Yu, Tong;Liu, Zhao
目的：总结胸腹主动脉病变全血管内修复的经验和效果，利用3D打印模型指导主动脉支架移植现场开窗。材料与方法：2018年4月至2019年3月，我科收治34例胸腹主动脉疾病患者，平均年龄58±14岁，男性24例。胸腹主动脉夹层19例，胸腹动脉瘤15例。术前，根据ct图像制作主动脉3D打印模型。在手术室中，在3D打印模型中完全释放主动脉主干支架，并在支架上标记出各开窗或分支的位置。然后用电笔制作开窗。金属丝用不可吸收的缝合线缝在开窗边缘。定制后，主动脉支架移植物被重新装入输送鞘并展开。结果：打印过程耗时约5小时（图像重建1小时，打印3小时，后处理1小时）。医生改良的支架移植物共有107个开窗，102个桥接支架移植物，包括73个覆盖支架和29个裸支架。平均手术时间为5.6±1.2小时，包括支架定制平均1.3小时。无肾功能不全或截瘫发生。手术中失去了两条分支动脉。1例（3%）术后1周死于逆行夹层破裂。1例患者术后发生轻度脑梗死。平均随访时间为8.5个月。有1例开窗内漏（线圈栓塞）和4例远端主动脉夹层破裂（3例治疗，1例观察）。结论：三维打印技术可用于指导胸腹主动脉重要分支病变开窗支架的制作。该技术似乎比传统的测量方法更准确，短期随访证明了该方法的安全性和可靠性。然而，还需要进一步的研究和开发。
Purpose:To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts.Materials and Methods:From April 2018 to March 2019, 34 patients (mean age 58 +/- 14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed.Results:The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6 +/- 1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed).Conclusion:Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.