A Pilot Study Assessing the Impact of 3-D Printed Models of Aortic Aneurysms on Management Decisions in EVAR Planning

Abstract

Introduction: Endovascular repair of aortic aneurysms with difficult anatomy is challenging. There is no consensus for planning such procedures. Methods: Six cases of aortic aneurysms with challenging anatomical features, such as short, angulated, and conical necks and tortuous iliacs were harvested. The computed tomography (CT) scans were anonymized. Lifesize 3-dimensional (3-D) printed models were created of the lumen. Endovascular operators were asked to review the CT angiography (CTA), make a management plan, and give an indication of their confidence. They were then presented with the equivalent model and asked to review their decision. Their attitudes to such models were briefly surveyed. Results: A total of 28 endovascular operators reviewed 144 cases. After review of the physical model, the management plan changed in 29 (20.1%) of 144 cases. Initial plan after CTA review was endovascular 73.6%, open repair 22.9%, and second opinion 3.5%. After model review, this became endovascular 67.4%, open repair 19.4%, and second opinion 4.8%. Although the general trend was toward more open procedures, off-label techniques reduced from 19.4% to 15.2% following model review. When the management plan did not change, level of confidence did increase in 37 (43.5%) of 85 cases. The majority of operators stated that they would find models useful for planning in some procedures. For 1 case, the change in the percentage of participants being sure in the management plan was statistically significant (P ¼ .031). Conclusion: The 3-D printed models may be potentially useful in planning cases with EVAR. It is a paradigm that warrants further investigation.

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

“…Use of 3D printed models can aid understanding of complex anatomy, device selection, and design of prosthesis best suited for patient’s anatomy. These models have shown to be useful in planning procedures and increase operator confidence [ 491 ]. 3D printed models have also been used to precisely place fenestrations on stent grafts to treat complex aneurysms [ 479 , 567 ].…”

Artificial vascular models for endovascular training (3D printing)

“…Tam et al [38] conducted a pilot study to investigate the role of 3D-printed models in surgical planning and clinical decision making for cases with aortic aneurysms with challenging anatomical features (e.g. short, angulated or conical necks).…”

“…After planning the procedure based on the patients’ angioCT, the surgeons were presented with the equivalent 3D-printed models and asked to review their decisions. The plan changed in 20% of the cases, and the level of confidence increased in 43% [38].…”

Decision-making based on 3D printed models in laparoscopic liver resections with intraoperative ultrasound: a prospective observational study

“…There is a major gap in literature regarding how 3DP models affect decision-making and, most importantly, clinical outcomes. Although a few recent publications attempted to quantitatively assess 3DP impact, most research provided conclusions based on questionnaires and subjective results [12]. This is also the case with the field of liver resections as no prospective studies have been published so far, especially involving IOUS use.…”