A Fenestration Template for Endovascular Repair of Juxtarenal Aortic Aneurysms

描述（由申请人提供）：主动脉瘤是主动脉的扩大，由于可能破裂而造成健康威胁。通过血管内覆膜支架（覆膜支架）进行微创修复已成为一种可行的治疗选择，可避免传统开放手术修复的风险。但是，这些覆膜支架仅在能够将其放置在稳定位置而不覆盖主要分支血管时使用。这通常将肾动脉附近腹主动脉瘤（近肾动脉瘤）患者排除在血管内治疗之外。为了允许对更广泛的动脉瘤病例进行腔内修复，外科医生有时会在覆膜支架上切孔，以适应特定的分支血管起源，这一过程称为“开窗术”。基于血管起点的CT图像定位开口。测量纵向距离，并从参考点估计相对角位置。然而，这些手动测量花费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、更准确的覆膜支架开窗术，我们建议开发一种自定义模板，作为覆膜支架开窗术的指南。我们将使用患者的CT图像数据来生成3D刚性套管，该套管代表包含感兴趣的分支血管的主动脉段。套管将使用3D打印机生产，并且其将包括在分支血管起点位置处的孔。然后可以对套管进行灭菌，在覆膜支架上滑动，并旋转以避免将孔定位在支架支柱上。开口可以在套筒就位的情况下切割，或者可以用无菌笔标记它们的位置并在套筒移除的情况下切割。由于套管是根据每个患者主动脉的图像生成的，因此模板确保所有开孔的精确角度和纵向放置，以匹配主动脉分支血管。快速准确的自定义开窗方法将节省手术成本，并使更多患者可以使用微创动脉瘤修复术。

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.