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Physician-modified endograft using three-dimensional model-assisted planning.

Hiroshi Mitsuoka1, Yasuhiko Terai1, Yuta Miyano1

  • 1Vascular and Endovascular Center, Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.

Journal of Vascular Surgery Cases and Innovative Techniques
|December 12, 2022
PubMed
Summary
This summary is machine-generated.

Three-dimensional (3D) model-assisted planning enhances fenestration design precision for endovascular grafting. This method improves accuracy, especially considering stent graft conformation to aortic anatomy, leading to successful outcomes.

Keywords:
Abdominal aortic aneurysmFenestrated endovascular aneurysm repairJuxtarenalParavisceralSimulation

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Area of Science:

  • Vascular Surgery
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Physician-modified endovascular grafting relies on accurate planning.
  • Three-dimensional (3D) models offer case-specific, true-to-scale representations.
  • 3D models are increasingly utilized for complex endovascular procedures.

Purpose of the Study:

  • To validate the use of 3D model-assisted planning for fenestration design in aortic aneurysm repair.
  • To assess the precision of 3D model-assisted planning compared to standard manual methods.
  • To evaluate the impact of anatomical factors on planning discrepancies.

Main Methods:

  • Retrospective analysis of 32 patients with aortic aneurysms or endoleaks.
  • Comparison of manual planning (curved planar reconstruction, multiplanar images) with intraoperative 3D model-assisted planning.
  • Assessment of intermethod agreement for geometrical relationships and fenestration mismatches.

Main Results:

  • Fourteen fenestration measurement discrepancies and twelve fenestration mismatches were observed.
  • Stent graft size, aortic angle, and prior stent graft presence significantly impacted measurement discrepancies.
  • Aortic angle significantly affected fenestration mismatches, with a cutoff of 36.5° identified.
  • 100% branch preservation was achieved with no fenestration-related complications during follow-up.

Conclusions:

  • Differences between manual and 3D model-assisted planning are non-negligible.
  • 3D model-assisted planning enhances fenestration design precision, particularly when considering stent graft conformation.
  • The study supports the utility of 3D models for improving fenestration accuracy in complex aortic repairs.