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Role of 3D Printing in Abdominal Aortic Aneurysm Cases

September 21, 2017 8:50 am
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3D printing plays a significant role in medical which is a powerful technology that continues to improve medical practice.  Its impact on the treatment of complex abdominal aortic aneurysms (AAA) continues to progress towards excellence as the technology advances.
 

The Jacobs Institute reports that clinical simulation using patient-specific 3D models in JAAA cases is more effective at planning for peri-procedural challenges and complications than standard pre-surgical planning using CTA diagnostic imaging alone. In this study, a patient-specific model was printed on the Stratasys Eden 260 printer using FullCure 930 TangoPlus, a flexible photopolymer with material tensile strength mimicking AAA lumen wall tissue.  Fluoroscopic guided simulation of the patient-specific procedure was performed by interventionists using custom-made endografts and all accessory devices.
 

The study found that seven out of ten (70%) procedural steps of the original planned procedure based on CTA imaging were changed after simulation on the 3D printed model. Possible complications were identified such as: 1) the need for fenestrated graft realignment during deployment, 2) challenging positioning of a renal stent, 3) identification of the need for a longer renal stent post-deployment, and 4) the necessity to confirm distal body graft ostium access via balloon inflation prior to iliac limb graft advancement. The authors conclude, “These impactful lessons require a surplus of time in a risk-free environment, which are not feasible in a patient procedure.”
 

The Department of Surgery, São Paulo University Medical School, Brazil finds training with patient -specific 3D models prior to EVAR improved residents’ surgical performance and increased their self-confidence.  Fluoroscopy time, total procedure time, and the amount of contrast used during surgery were significantly reduced when compared with procedures performed by vascular residents trained only according to the routine practice of the institution. The study concludes that 3D models offer a cost-effective solution over virtual or other commercially available simulators.
 

With advancements in 3D printing technology, the clinical applications continue to evolve.  The Department of Engineering San Sabastian, Spain reports applying multi-material 3D printing technology to enhance the realism of the model using the Objet260 Connex 2 printer based on the PolyJet technology and digital materials FLX9940 and FLX9960 (Stratasys Ltd., Minneapolis, MN, USA) The model produced demonstrated the same mechanical properties as human AAA tissue making it a valuable asset for surgical planning and education.