Low-Cost Digital Tools for Endovascular Aortic Aneurysm Repair Sizing and Planning

Abstract

Preoperative planning and appropriate device selection have been shown to significantly reduce the rate of type 1 endoleak and secondary re-intervention rates. Precise anatomical measurement for endovascular aortic repair (EVAR) planning and stent graft selection is critical to obtain favorable outcomes when there is a lack of 3D workstations, specialized software, or advanced image techniques like 3D fusion digital subtraction angiography (FDSA) and intravascular ultrasonography (IVUS). This chapter describes available methods to improve the sizing and planning technique using open-source and low-cost universally available digital tools that can be used to plan TEVAR, F/BEVAR, infrarenal EVAR, and covered endovascular reconstruction of the aortic bifurcation (CERAB) cases. These designing tools can help teams overcome technical limitations due to the lack of FDSA, IVUS, costly imaging workstations, or advanced vascular software, a typical scenario in many countries. Using the described digital toolkit to size, measure, and plan graft selection and procedure execution in complex aorta endovascular repair offers multiple advantages, such as quick availability, low costs, knowledge of patient anatomy, 3D modeling, and printing. 3D modeling can help the accuracy of fenestrations in back-table physician-modified cases, especially in urgent cases with complex anatomy. Vector design software has advantages such as layers, transparencies, and node-based tracing to enhance the process and improve visualization. This produces high-quality images with a 1:1 proportion that can be used in the OR and easily distributed to team members involved with patient care. This might prove most beneficial in developing countries where advanced imaging hardware and software are scarce and cost-prohibitive.