Daniel F. Leotta, PhD, Benjamin W. Starnes, MD

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Presentation transcript:

Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms Daniel F. Leotta, PhD, Benjamin W. Starnes, MD Journal of Vascular Surgery Volume 61, Issue 6, Pages 1637-1641 (June 2015) DOI: 10.1016/j.jvs.2015.02.016 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 Three-dimensional (3D) display of the traced lumen contours of the abdominal aortic aneurysm (AAA) proximal neck for the demonstration data set. The branch vessel origin locations are displayed as spheres. Journal of Vascular Surgery 2015 61, 1637-1641DOI: (10.1016/j.jvs.2015.02.016) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 Fenestration template computer-assisted design model. The lumen contours shown in Fig 1 were converted to a solid model format compatible with a three-dimensional (3D) printer. A, Polygon model of the aneurysm proximal neck. B, Combined display of the proximal neck model and cylinders at each of the branch vessel origins. The cylinder diameters are set to match the branch vessel opening diameters as measured from the original computed tomography (CT) images. SMA, Superior mesenteric artery. C, The result of the Boolean difference between the proximal neck object and each cylinder is a hole in the aorta model at the location of each of the branch vessel origins. Journal of Vascular Surgery 2015 61, 1637-1641DOI: (10.1016/j.jvs.2015.02.016) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 Three-dimensional (3D)-printed fenestration template. A, Computer model of the template. B, Solid printed model of the template created using a stereolithography 3D printer with clear resin. C, An endovascular graft inserted in the template. Journal of Vascular Surgery 2015 61, 1637-1641DOI: (10.1016/j.jvs.2015.02.016) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 Phantom for fenestration template validation. A, An off-the-shelf model of an abdominal aortic aneurysm (AAA) that includes the renal arteries. B, Tubes were attached to the AAA phantom to represent the celiac artery and the superior mesenteric artery, and the phantom was embedded in agar in a plastic container. C, The phantom was imaged with a standard computed tomography (CT) scanner. Journal of Vascular Surgery 2015 61, 1637-1641DOI: (10.1016/j.jvs.2015.02.016) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 5 Graft fenestration and deployment for validation. A, An unsheathed graft is inserted in the fenestration template and the branch vessel origins are marked with a pen. B, Fenestrations are cut with an electrocautery device after removal of the template. Journal of Vascular Surgery 2015 61, 1637-1641DOI: (10.1016/j.jvs.2015.02.016) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 6 Fluoroscopic confirmation of proper alignment of the graft fenestrations with each of the branch vessels in the abdominal aortic aneurysm (AAA) phantom. A guidewire was successfully deployed through the openings in the fenestrated graft into each of the branch vessels. Gold markers sewn around the graft openings are visible for each fenestration. A, Celiac artery; B, Superior mesenteric artery; C, Left renal artery; D, Right renal artery. Journal of Vascular Surgery 2015 61, 1637-1641DOI: (10.1016/j.jvs.2015.02.016) Copyright © 2015 Society for Vascular Surgery Terms and Conditions