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.
Proc. SPIE. 9789, Medical Imaging 2016: PACS and Imaging Informatics: Next Generation and Innovations
KEYWORDS: Medicine, Visualization, Imaging systems, Image segmentation, Image processing, Heart, 3D modeling, 3D printing, Printing, Angiography, Fluoroscopy, Cardiology, 3D image processing, Imaging informatics, Picture Archiving and Communication System
3D printing an anatomically accurate, functional flow loop phantom of a patient’s cardiac vasculature was used to assist
in the surgical planning of one of the first native transcatheter mitral valve replacement (TMVR) procedures. CTA scans
were acquired from a patient about to undergo the first minimally-invasive native TMVR procedure at the Gates Vascular
Institute in Buffalo, NY. A python scripting library, the Vascular Modeling Toolkit (VMTK), was used to segment the 3D
geometry of the patient’s cardiac chambers and mitral valve with severe stenosis, calcific in nature. A stereolithographic
(STL) mesh was generated and AutoDesk Meshmixer was used to transform the vascular surface into a functioning closed
flow loop. A Stratasys Objet 500 Connex3 multi-material printer was used to fabricate the phantom with distinguishable
material features of the vasculature and calcified valve. The interventional team performed a mock procedure on the
phantom, embedding valve cages in the model and imaging the phantom with a Toshiba Infinix INFX-8000V 5-axis Carm
bi-Plane angiography system.
Results: After performing the mock-procedure on the cardiac phantom, the cardiologists optimized their transapical
surgical approach. The mitral valve stenosis and calcification were clearly visible. The phantom was used to inform the
sizing of the valve to be implanted.
Conclusion: With advances in image processing and 3D printing technology, it is possible to create realistic patientspecific
phantoms which can act as a guide for the interventional team. Using 3D printed phantoms as a valve sizing
method shows potential as a more informative technique than typical CTA reconstruction alone.