Initial Experience with Fenestrated Physician-Modified Stent Grafts Using 3D Aortic Templates

Area of Science:

• Vascular Surgery
• Medical Device Technology
• 3D Printing Applications

Background:

• Complex aortic aneurysm repair presents significant challenges.
• Physician-modified endografts (PMEG) offer a tailored approach.
• 3D aortic templates can aid in complex endovascular procedures.

Purpose of the Study:

• To evaluate the surgical outcomes of PMEG using 3D aortic templates in a center with no prior complex endovascular aortic repair experience.
• To assess the feasibility and safety of integrating 3D printing technology into PMEG modification.
• To analyze complication rates and patency in patients undergoing PMEG for challenging aortic pathologies.

Main Methods:

• Forty-three patients with juxtarenal/suprarenal aneurysms, type IV thoracoabdominal aneurysms, or type IA endoleak underwent PMEG implantation.
• Patient-specific 3D aortic templates were created from CT angiography scans for stent graft modification.
• A total of 162 fenestrations were reinforced, with a mean modification time of 86 minutes.

Main Results:

• The 30-day mortality rate was 12%, and the overall endoleak rate was 28% (12% type I/III, 16% type II).
• Follow-up patency rates were high: 95% for SMA, 93% for right renal, 95% for left renal, and 89% for celiac.
• Despite successful integration of 3D printing, surgical metrics were worse than reported for experienced centers.

Conclusions:

• 3D printing technology can be integrated into PMEG modification practices.
• Centers initiating complex endovascular aortic repairs with PMEG and 3D templates may experience suboptimal surgical outcomes.
• Further experience and specialized training are crucial for optimizing PMEG outcomes in complex aortic cases.