Customized blood vessel models for optimal catheter choice: Two instances of aneurysm obstruction
In a groundbreaking development, the use of three-dimensional (3D) printed, patient-specific vascular models is revolutionising complex aneurysm coil embolization procedures. These models offer significant benefits by enabling precise preoperative simulation and planning, improving procedural accuracy and safety.
A transparent, flexible, and highly slippery vascular model was developed to address the limitations of traditional models. This innovative model has demonstrated its utility in procedures involving renal arteriovenous malformations. In a recent case, a female patient in her 40s presented with a 5 × 5 mm saccular aneurysm at the origin of the dorsal pancreatic artery, branching from the SMA.
The models, printed using flexible, transparent materials, were coated with silicone and connected to a sheath in a white box for endovascular procedure simulation. Preoperative simulations using these models facilitated preselection of the optimal catheter, minimizing the need for intraoperative catheter exchange.
One of the key advantages of these models is personalised procedural planning. Surgeons and interventionalists can visualize and physically interact with the patient's unique vascular geometry. Mechanical assessment is another benefit, as the models allow evaluation of the mechanical behavior of coils within realistic vessel-like structures.
The models serve as a realistic simulation platform for practicing complex maneuvers in a risk-free environment. They also aid in reducing procedural time and complications by identifying anatomical challenges beforehand.
Most existing patient-specific vascular models either lack hollow structures or are small-scale hollow models that replicate only aneurysms and adjacent inflow and outflow vessels. However, the models used in this case were hollow, with a wall thickness of 1.0 mm, and were capable of simulating catheter insertion into the primary branches of the aorta.
Coil embolization of peripheral aneurysms in the trunk region requires sufficient catheter stability and precise placement of an appropriate catheter in the primary branch of the aorta. Using the simulation, it was determined that a 4.5-Fr guiding sheath and a 4-Fr Rösch hepatic catheter would provide sufficient backup support for accurate coil placement.
Preoperative simulations using patient-specific vascular models offer a potential solution by reducing the need for catheter replacement, shortening the time required for catheter engagement and placement, and minimizing intimal damage risk.
While advances like the use of augmented reality and AI are enhancing cerebrovascular interventions broadly, 3D printed patient-specific models are currently important for improving the precision and safety of complex coil embolizations by providing a tangible, accurate representation of the aneurysm and surrounding vasculature.
The models were created using DICOM data from 3D CTA images, MeshMixer software, PreForm software, and a Form 3L 3D printer. After rinsing with isopropyl alcohol, drying, and curing, the models were ready for use. The patient was referred to the department for prevention of aneurysm rupture due to the proximity of the aneurysm to the SMA trunk. The same catheters used in the simulation were employed in the actual procedure via the right femoral approach, and embolization was successfully completed with no complications.
In conclusion, the use of 3D printed patient-specific vascular models is a promising development in the field of interventional radiology. These models offer a realistic, tangible representation of a patient's unique vascular anatomy, enabling surgeons to rehearse complex procedures, evaluate device fit and mechanical resistance, and anticipate technical challenges before the actual intervention. This tailored simulation helps optimize device selection and deployment strategies, potentially reducing intraoperative complications and improving treatment outcomes.
These 3D printed vascular models, a product of science and technology, are revolutionizing the field of interventional radiology by providing a realistic simulation environment for complex procedures like aneurysm coil embolization. By mimicking a patient's unique vascular geometry, they aid in health-and-wellness by reducing procedural time, complications, and the need for fitness-and-exercise-intensive intraoperative adjustments. Their utility extends to various medical-conditions, creating an opportunity for fine-tuning sport-related strategies, ensuring improved safety and efficacy in treatment methods.
