Abstract:

3D printing guiding stent graft fenestration in endovascular aneurysm repair for complex aortic arch diseases        LIU Chang-jian，LIU Zhao. Department of Vascular Surgery，Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School，Nanjing 210008，China
Corresponding author： LIU Chang-jian，E-mail：dr_cjliu@
hotmail.com
Abstract    The aortic arch diseases which involve important branches have high mortality and complications. It is one of the most difficult clinical challenges. The 3D printing aortic arch model can intuitively help surgeons to understand and determine the 3D relationships between aortic arch lesions and branches. Thus，it could provide guidance for TEVAR surgeries and making surgical plans. Moreover，the stent-graft can be deployed inside the 3D model and the branch opening localizations can be confirmed before operation. The authors introduced a new method of treatment for aortic arch diseases with triple pre-fenestrated stent-graft under 3D printing guidance.The procedure mainly includes：（1） data collection and 3D printing model production before the operation；（2）accomplish the fenestration and reduction of the diameter of the stent graft by physicians on table during the operation；（3） deploy the aortic stent graft and branched stent grafts. The novel method has plenty of advantages：（1） the commercial thoracic aortic stent graft can be used for physician-modified stent-graft （PMSG），which is cheap，and 3D printing model preparation can be completed within 6 hours.It takes a short time and even maybe used for emergency patients；（2）the procedure is relatively simple and has short learning curve. Therefore，experienced vascular surgeons can be competent to implement it quickly after short-term training;（3）the 3D printing model can greatly improve the accuracy of pre-fenestration for aortic arch lesions with complex anatomical structures；（4）the procedure is convenient and safe，with minimal trauma and quick recovery. There is no need for blood transfusion，extracorporeal circulation or hypothermia circulation；（5）Because of reduction of stent graft and fenestrations，the blood supply of brain is sufficient during operation. The complicated procedure of extracorporeal bypass during triple in-situ fenestration can be avoided. As a result，it reduces the cerebral complications significantly. No death and type I inner leakage occurr during early postoperative follow-up，but the medium and long-term results remain to be further observed.

Key words: 3D printing, fenestrated stent-graft, physician-modified stent-graft, thoracic endovascular aortic repair

摘要：

累及主动脉重要分支部位的主动脉弓部的病变有较高的病死率和并发症发生率，仍是临床治疗上有待解决的最困难的严重挑战。3D打印技术重建的主动脉弓部模型能直观了解和确定主动脉夹层和主动脉瘤与弓部动脉分支之间的3D关系，从而为胸主动脉腔内修复术（TEVAR）治疗这些动脉疾病提供指导和制定手术方案，还可以术前在模型内模拟血管腔内支架释放和分支开口定位。作者介绍了一种3D打印技术引导预开窗TEVAR手术治疗涉及主动脉弓部的主动脉瘤和主动脉夹层的新方法。手术过程主要包括：（1）术前数据采集和3D打印模型的制作。（2）术中支架移植物开窗和束径。（3）主动脉支架和分支支架移植物置放。该手术方法具有以下优势：（1）应用现有的商品胸主动脉支架医生术中改制支架移植物（physician-modified stent-graft PMSG），费用低，3D打印模型制备可以在6 h内完成，所用时间短，甚至可用于急诊病人。（2）手术操作相对简单，学习曲线短，有经验的血管外科医生经过短期训练很快能胜任实施。（3）3D打印模型能大大提高复杂解剖结构弓部病变体外支架预开窗的准确性。（4）手术方便安全、创伤小，恢复快，不需要输血，也不需要体外循环和低温停循环。（5）因为释放开窗和束径的胸主动脉支架时脑部仍有充足的血流供应，避免了原位开窗时较为繁琐的体外转流步骤，明显减少了脑部并发症。术后早期随访，无死亡和Ⅰ型内漏发生，但中长期结果还有待进一步观察。

关键词: 3D打印, 支架移植物开窗, 改制支架移植物, 胸主动脉腔内修复