Utility of 3D Printing in Endovascular Repair of Endoleaks

Purpose: Endoleaks, which are a common complication after endovascular aneurysm repair (EVAR), result from retrograde blood flow into the aneurysm sac. Adequate visualization of patient’s unique anatomy, appropriate device selection, and prediction of intraoperative navigational difficulties are paramount to successful endovascular repair of endoleaks. The purpose of this abstract is to evaluate feasibility of using patient-specific 3D printed models for preprocedural planning, simulation, and approach selection before endovascular repair of endoleaks. Although 3D printing has become increasingly prevalent in preprocedural planning of EVAR, to our knowledge, this is the first proposal describing the utility of 3D printing in endovascular repair of endoleaks.

Materials and Methods: To evaluate feasibility of 3D printing, an 87-year-old man with a large type II endoleak and expanding aneurysm sac status post EVAR was selected. The patient had embolization of one lumbar and inferior mesenteric artery via percutaneous translumbar approach. Preprocedure images from computed tomographic angiography were converted into digital 3D objects using Materalise Mimics Medical, a segmentation software. After the 3D model was created, additional edits and model refinements were made using Materialise 3-Matic Medical and 3D Systems Geomagic Freeform. A Poly jet 3D printer, Stratasys j750, was used to print a model of the aneurysm sac and aortic branch vessels using multicolor resin. The intraoperative angiogram findings were used to assess anatomic accuracy of the printed model. An interventional radiologist used the 3D printed model to retrospectively simulate the procedure and compare observations with actual intraoperative findings.

Results: The 3D printed model was found to provide enhanced spatial understanding of the complex anatomy, provide a physical object on which to simulate the procedure, and allow identification of potential navigational difficulties. The model allowed trial of various techniques and selection of optimal approaches and devices. In addition, it was helpful in trainee education.

Conclusions: 3D printing is an emerging technology that offers advanced visualization of the unique anatomy of each patient, prediction of intraoperative navigational difficulties, and simulation. It also aids in the selection of presurgical devices and approaches. 3D printing also has utility in patient and trainee education.