Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been
enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise
orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D
printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation
environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit
(VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR)
was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated
and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to
simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed
by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy
between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme.
Results: With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural
strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical
environment. The actual patient procedure went without complications.
Conclusions: With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with
3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.
Karen M. Meess, Richard L. Izzo, Maciej L. Dryjski, Richard E. Curl, Linda M. Harris, Michael Springer, Adnan H. Siddiqui, Stephen Rudin, and Ciprian N. Ionita, "3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system," Proc. SPIE 10138, Medical Imaging 2017: Imaging Informatics for Healthcare, Research, and Applications, 101380P (Presented at SPIE Medical Imaging: February 16, 2017; Published: 13 March 2017); https://doi.org/10.1117/12.2253902.
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