Intraoperative positioning system-guided antegrade in situ laser fenestration in an aortic model

Area of Science:

• Vascular Surgery
• Medical Device Technology
• 3D Printing in Medicine

Background:

• Fenestrated endovascular aneurysm repair (fEVAR) is crucial for complex aneurysms but faces challenges like long procedure times, high radiation, and contrast use.
• Centerline Biomedical's intraoperative positioning system (IOPS) offers 3D surgical navigation and visualization to address these fEVAR limitations.

Purpose of the Study:

• To evaluate the feasibility of IOPS-guided in situ laser fenestration for fEVAR in a thoracoabdominal aortic aneurysm phantom model.
• To assess the potential of IOPS to reduce radiation exposure and procedure time in fEVAR.

Main Methods:

• A 3D-printed thoracoabdominal aortic aneurysm phantom was used for an experimental fEVAR procedure.
• IOPS guided in situ laser fenestrations for visceral vessel incorporation, followed by bridging stent placement.
• Radiation use was minimized, limited to cannulation confirmation and completion imaging.

Main Results:

• Successful deployment of a thoracic endograft and precise in situ laser fenestrations for all visceral vessels.
• Completion angiogram confirmed widely patent renal, celiac, superior mesenteric, and inferior mesenteric arteries with accurate stent graft alignment.
• Specific cannulation times were recorded for each visceral artery, with the left renal artery taking the longest.

Conclusions:

• IOPS-guided in situ laser fenestration shows early feasibility as a radiation-sparing technique for fEVAR in a phantom model.
• This approach may obviate prestenting procedures and expedite fEVAR, reducing overall procedure time.
• Further research is needed to evaluate the safety and efficacy of IOPS in human fEVAR procedures.