A Fenestration Template for Endovascular Repair of Juxtarenal Aortic Aneurysms

描述(由申请人提供)：主动脉瘤是指由于潜在的破裂而对健康造成威胁的主动脉增大。微创修复血管内支架(内移植物)已成为一种可行的治疗选择，以避免传统的开放手术修复的风险。然而，只有当移植物可以放置在稳定的位置而不覆盖主要分支血管时，才能使用这些内移植物。这通常不包括与肾动脉相邻的腹主动脉瘤(肾旁动脉瘤)患者的血管内治疗。为了能够对更广泛的动脉瘤病例进行血管内修复，外科医生有时会在支架移植物上切开洞，以适应特定的分支血管起源，这一过程被称为“开窗”。这些开口是根据血管起源的CT图像定位的。测量纵向距离，并从参考点估计相对角度位置。然而，这些手动测量需要时间，并且可能导致开口位置的误差，特别是当必须容纳多个分支时。为了提供更快和更准确的移植物内开窗，我们建议开发一种定制模板来作为移植物开窗的指南。我们将使用患者的CT图像数据来生成3D刚性袖子，表示他们的主动脉包含感兴趣的分支血管的部分。套筒将用3D打印机生产，它将在分支血管起点的位置上包括孔。然后，可以对套筒进行消毒，将套筒滑过内移植物，然后旋转，以避免将孔定位在支架支柱上。可以在套筒就位的情况下切割开口，也可以用无菌笔标记开口的位置，然后在去掉套筒的情况下进行切割。由于袖子是从每个患者的主动脉图像生成的，该模板确保了所有开窗的准确角度和纵向位置，以匹配主动脉分支血管。一种快速而准确的定制开窗方法将节省手术成本，并使更多的患者可以使用微创动脉瘤修复程序。

DESCRIPTION (provided by applicant): Aortic aneurysms are enlargements of the aorta that pose a health threat due to potential rupture. Minimally-invasive repair by endovascular stent grafts (endografts) has become a viable treatment option that avoids the risk of traditional open surgical repair. However, these endografts can only be used when the graft can be placed in a stable position without covering major branch vessels. This typically excludes patients with abdominal aortic aneurysms adjacent to the renal arteries (juxtarenal aneurysms) from endovascular treatment. To allow for endovascular repair of a wider range of aneurysm cases, surgeons will sometimes cut holes in the stent grafts to accommodate specific branch vessel origins, a process known as 'fenestration'. The openings are located based on CT images of the vessel origins. Longitudinal distances are measured, and relative angular locations are estimated from a reference point. However, these manual measurements take time and can lead to errors in the positions of the openings, particularly when multiple branches must be accommodated. To provide for faster and more accurate endograft fenestration, we propose the development of a custom template to serve as a guide for graft fenestration. We will use a patient's CT image data to generate a 3D rigid sleeve representing the segment of their aorta encompassing the branch vessels of interest. The sleeve will be produced with a 3D printer and it will include holes at the locations of the branch vessel origins. The sleeve can then be sterilized, slipped over the endograft, and rotated to avoid positioning the holes over stent strut. The openings can be cut with the sleeve in place, or their locations can be marked with a sterile pen and cut with the sleeve removed. Because the sleeve is generated from images of each patient's aorta, the template assures accurate angular and longitudinal placement of all fenestrations to match the aorta branch vessels. A fast and accurate custom fenestration method will save procedural costs and make minimally-invasive aneurysm repair procedures available to more patients.