Case analysis: 3D printing-assisted endoluminal isolation of an abdominal aortic aneurysm with covered stent-graft

1. Presentation of the case

patient woman,68At the age of 2, he was hospitalized following the discovery of an abdominal aortic aneurysm. Auxiliary examination: abdominal aortaCall to actionThe diagnosis was abdominal aortic aneurysm with intratumoral thrombosis, bilateral common iliac artery aneurysm, early stenosis of both renal arteries, and left renal stone with severe hydrops.

2. Surgical plan

1、 3DPrint abdominal aortic aneurysms and branch vessels to fully understand blood vessel anatomy.

2The left and right common iliac arteries are tortuous, and the positions of the left and right renal arteries are quite different.

3、 3DBlood vessel printing provides a reference for the formulation of surgical plans and the selection of vascular stents.

4two vascular staplers were inserted into the femoral arteries on both sides.

5、 Aegisbranch support

6Pay attention to the soft sheath when using8CharacterBrandalignment of points

7Branch stent release technique and force

8,Solution for branch guide wire winding

9three-dimensional and spatial sense andDSA2D view

3. Surgical process

1.according to3DPrint the surgical plan formulated for blood vessels, abdominal aorta angiography, and indicate the location of the aneurysm and branches of each blood vessel.

2In order to avoid the formation of internal fistulas at the junction of the external and internal iliac arteries after release of the stent, the internal iliac artery is previously embolized.

3establish access to the bifemoral artery; bilateral catheters meet at the level of the abdominal aorta;

4,according to3DPrinting the blood vessel model makes stent placement easier. Access to the right femoral artery to introduce the stent body,The branch guidewire is evacuated from the body and the abdominal aortic segment is partially released.

5adjust the stent position during angiography and adjust the guidewire winding problem,Pay attention to the positional relationship between the left and right renal arteries

6release the main body of the stent after the contrast is clear and the direction is clear;

7.After the main stent was released, angiography showed that the branches of the left and right iliac arteries were not obstructed.

8adjust the left and right catheter guidewires and introduce the left and right iliac artery split stents

9once the main bracket and left and right split brackets are released,I found that the support did not fit well,Dilation of the balloon

10,exist3DCompleted Endoluminal Isolation of Abdominal Aortic Aneurysm Using Printed Blood Vessels, Final Angiographic Results

4. Problems Existing During Surgery

1 The patient’s blood vessels are tortuous, the left and right iliac arteries have a complicated course, and the left and right renal arteries are in different positions, which increases the difficulty and risk of the operation.

2 Due to the large tumor cavity,DSAShows poor results for abdominal aortic aneurysms.

3 The situation inside the blood vessels is complex, and the operation of the catheter guide wires in the blood vessels is complicated and easy to entangle.

4After the stent was released, it was found that the fit between the stent and the blood vessel was poor.

5. Preoperative3ofDAdvantages of printed adjuvant treatment of aneurysms

1.existCall to actionThe diagnosis is more intuitive and precise based on

2.Helps surgeons design surgical plans

3.Facilitate communication with patients and their families

4.Facilitate patient selection of personalized surgical instruments (such as stent customization)

5.How to avoid risks and their plans

6.For patients who need to open a window, it can be precisely positioned

6. Case Summary

1 Rigorous scientific planning is required when formulating a surgical plan;

2Every detail must be taken into account during operation;

3Preoperative understanding of the patient’s anatomical anatomy is very important for surgery;

4 This example may seem complicated only by the anatomical structure, but in fact the operation is also very complicated;

5 The branch recovery situation requires particular attention and close monitoring;

6Choose the appropriateAegissupport andAegisStrategies for using stents can provide good results.

7 3DImpression-assisted treatment of abdominal aortic aneurysms can help formulate surgical plans, especially for abdominal aortic aneurysms with complex anatomy.

source:Ganzhou Guangdong Provincial People’s Hospital