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Measurements and time requirements of graft reconstruction using DGM, IBT, MBT, and GBT. DGM designed graft model, IBT image-based technique, GBT guide-based technique. *There was a statistically significant difference between IBT and MBT, between IBT and GBT, and between MBT and GBT.
Source publication
In thoracoabdominal aortic aneurysm repair, repairing the visceral and segmental arteries is challenging. Although there is a pre-hand-sewn and multi-branched graft based on the conventional image-based technique, it has shortcomings in precisely positioning and directing the visceral and segmental arteries. Here, we introduce two new reconstructio...
Contexts in source publication
Context 1
... of accuracy and marking time requirement of DGM and three techniques. Table 2 presents the measurement of the diagonal line, height, and angle from the celiac artery to the segmental arteries for the DGM, whose design was validated by surgeons, conventional IBT, MBT, and GBT. According to the Bland-Altman analysis, the arithmetic mean and standard deviation (SD) of the difference between the DGM and conventional IBT were − 9.19 ± 16.47 mm (limits of agreement (LoA): − 41.47 to 23.08 mm) for the diagonal line, − 9.25 ± 16.84 mm (LoA: − 42.26 to 23.76 mm) for the height, and − 9.76° ± 10.05° (LoA: − 29.47° to 9.95°) for the angle (Fig. 5a-c), respectively; the difference between the DGM and MBT was − 1.67 ± 8.11 mm (LoA: − 17.56 to 14.21 mm) for the diagonal line, − 1.50 ± 8.60 mm (LoA: − 18.35 to 15.36 mm) for the height, and − 8.89° ± 10.93° (LoA: − 30.31° to 12.52°) for the angle (Fig. 5d-f), respectively. ...Context 2
... were statistically significant differences in all the measurements for the IBT, MBT, and GBT, except for the diagonal line of the GBT. The average marking time required for fenestrations of vessels excluding cutting out with three techniques are summarised in Table 2, and the time required for each of the 15 patients is shown in Supplementary Table S2. The MBT and GBT reduced the marking times by 17.6 and 15.5 min, respectively, compared with the conventional IBT. ...Context 3
... were statistically significant differences in all the measurements for the IBT, MBT, and GBT, except for the diagonal line of the GBT. The average marking time required for fenestrations of vessels excluding cutting out with three techniques are summarised in Table 2, and the time required for each of the 15 patients is shown in Supplementary Table S2. The MBT and GBT reduced the marking times by 17.6 and 15.5 min, respectively, compared with the conventional IBT. ...Context 4
... tended to appear in the IBT as the distances from the celiac artery from the segmental arteries increased in the diagonal line and height, and occurred in patient with tortuous and swelling aneurysm aorta or scoliosis in the angle (Fig. 5a-c). In the MBT, the difference ranges for diagonal line, height, and angle were − 21.92 to 20.39 mm, − 25.54 to 18.73 mm, and − 39.97° to 23.04°, respectively, and − 21. 22 to 19.29 mm, − 12.56 to 14.34 mm, and − 40.61° to 15.31°, respectively, in the GBT ( Table 2). The diagonal line and height in the MBT and GBT were distributed in the region of the negative difference, as the measured distance was smaller, indicating a positive difference as the measured distance increased. ...Context 5
... average time requirement for the MBT and GBT reduced by 17.4 and 15.5 min, respectively, showing the effect reduced by more than six times compared to IBT. In addition, although, based on the marking time, the MBT was more efficient than the GBT, the GBT had superior accuracy (Table 2 and Supplementary Table S2). ...Similar publications
Chemodectomas are low prevalence tumors with complex clinical management. Many present as an incidental finding however, in other dogs, they produce pericardial effusion and/or compression, leading to the appearance of severe clinical signs. There are currently several approaches: surgery, radiotherapy, stent placement and chemotherapy. This is the...
Citations
... Other research has evaluated the importance of accurate reproduction and 3D printing for proper assessment and preparation for surgery in cases of complex congenital heart disease (Borracci et al. 2020;Valverde et al. 2017;Yang et al. 2021). Finally, some studies have exploited virtual simulation as a guide and method for evaluating the final surgical configuration (Gallo et al. 2020;Kim et al. 2021;Sadeghi et al. 2022;Szugye et al. 2021). Currently, new technologies are mainly used to support preoperative surgical planning to improve its accuracy. ...
... Others that are more anatomically realistic tend to be very expensive, and even those may only be compatible with one imaging modality. Many methods for creating AAA models in the literature include the use of high cost or difficult-to-source materials and techniques, such as stereolithography with UV-curing resins [12] 13, so they cannot readily be reproduced for clinical training. Additionally, most current phantoms include only the vessel structures [14] without surrounding tissues, so that their realism and use with multimodality imaging are limited. ...
Purpose
Multimodality imaging of the vascular system is a rapidly growing area of innovation and research, which is increasing with awareness of the dangers of ionizing radiation. Phantom models that are applicable across multiple imaging modalities facilitate testing and comparisons in pre-clinical studies of new devices. Additionally, phantom models are of benefit to surgical trainees for gaining experience with new techniques. We propose a temperature-stable, high-fidelity method for creating complex abdominal aortic aneurysm phantoms that are compatible with both radiation-based, and ultrasound-based imaging modalities, using low cost materials.
Methods
Volumetric CT data of an abdominal aortic aneurysm were acquired. Regions of interest were segmented to form a model compatible with 3D printing. The novel phantom fabrication method comprised a hybrid approach of using 3D printing of water-soluble materials to create wall-less, patient-derived vascular structures embedded within tailored tissue-mimicking materials to create realistic surrounding tissues. A non-soluble 3-D printed spine was included to provide a radiological landmark.
Results
The phantom was found to provide realistic appearances with intravascular ultrasound, computed tomography and transcutaneous ultrasound. Furthermore, the utility of this phantom as a training model was demonstrated during a simulated endovascular aneurysm repair procedure with image fusion.
Conclusion
With the hybrid fabrication method demonstrated here, complex multimodality imaging patient-derived vascular phantoms can be successfully fabricated. These have potential roles in the benchtop development of emerging imaging technologies, refinement of novel minimally invasive surgical techniques and as clinical training tools.
The determination of mechanical properties of biological materials is a relevant and interdisciplinary topic of research. In this work we compared the stress–strain relationship of human thoracic aortic wall samples with polymeric 3D printing materials with vessel wall properties. Mechanical tests were performed on a standard test equipment (Instron 3365) in dogbone shaped samples. The physiological modulus of elasticity, the maximum modulus of elasticity, maximum stress and the deformation at the point of maximum stress were determined. The tests showed that mechanical failure consistently occurred in the middle region of the sample. Results of aortic samples obtained from two aortas (ao1 and ao2) showed a physiological elastic modulus of 0.68 ± 0.2 and 0.58 ± 0.4 MPa and maximum elastic modulus of 2.44 ± 0.3 and 2.18 ± 1.1 MPa, for ao1 and ao2, respectively. 3D printed samples of different material composition did not show a tensile stress in the physiological range with elastic modulus and maximum elastic modulus of 0.85 ± 0.04 and 0.95 ± 0.07 MPa, respectively. The results suggest the need of using a combination of materials or microstructures for modeling blood vessel wall mechanical properties.
Objectives:
Paraplegia is a distressing complication after open thoracoabdominal aortic aneurysm (TAAA) repair, and revascularization of T8-L2-level segmental arteries is considered pivotal to prevent paraplegia. We employed 3-dimensional (3D) printing to efficiently revascularize segmental/visceral arteries and prospectively evaluated its safety and efficacy.
Methods:
From January 1, 2020, to June 30, 2022, we prospectively enrolled patients of extent I, II, or III TAAA repair. Guidance models were 3D-printed based on preoperative computed tomography, and multibranched aortic grafts were manually constructed upon this model before surgery. The composite outcome of operative mortality, permanent stroke, and permanent spinal cord deficit (SCD) was compared with the historical control group (n = 77, in 2015-2020), subjected to similar TAAA repair without 3D printing.
Results:
A total of 38 patients (58.6 ± 13.2 years) underwent open TAAA repair with the aid of 3D printing. Extent I, II, and III repairs were performed in 14 (36.8%), 17 (44.7%), and 7 (18.4%), respectively. Concomitant arch repair and bi-iliac reconstruction were performed in 7 (18.4%) and 6 patients (15.8%), respectively. Mean pump time was 107.7 ± 55.5 minutes. Operative mortality, permanent stroke, and permanent SCD each occurred in 1 patient (2.6%), and the incidence of the composite outcome was 7.9% (3/38). In the control group, mean pump time was 166.0 ± 83.9 minutes, significantly longer than the 3D-printing group (P < .001), and operative mortality, permanent stroke, permanent SCD, and the composite outcome occurred in 7 (9.1%), 9 (11.7%), 8 (10.4%), and 19 (24.7%), respectively.
Conclusions:
Open repairs of extensive TAAA with 3D printing showed favorable safety and efficacy, which need further validation by larger studies.
