Utility of 3D printed abdominal aortic aneurysm phantoms: a systematic review

Abstract

Background: 3D printed (3DP) abdominal aortic aneurysm (AAA) phantoms are emerging in the literature as an adjunct for the visualization of complex anatomy, particularly for presurgical device selection and simulation. This is the first systematic review to provide a comprehensive overview of 3DP for endovascular aneurysm repair (EVAR) planning and intervention, evaluating the readiness of current levels of technology for mainstream implementation. Methods: A systematic literature search of PubMed and MEDLINE was performed as per PRISMA guidelines using the terms '3D Printing', 'AAA' OR 'EVAR' and related index terms, and further relevant articles were appraised via a snowballing approach. Our last search was conducted on 14 November 2020. Results: Twenty-five articles were identified for critical analysis, with 14 cases or technical reports. Nineteen publications utilized 3DP AAA phantoms to aid presurgical decision making, device selection and design. Four publications explored the utility of 3DP phantoms as EVAR trainers, and one publication examined the technology as a tool for patient education. Flexible, transparent phantoms were deemed most useful; however, the cost and availability of higher end machines limited accessibility. Conclusion: 3DP phantoms have been used in EVAR to facilitate visualization of complex patient anatomy, appropriate device selection, in predicting navigational difficulties and the shape and position of endograft after deployment. These phantoms show promise in reducing known complications such as endoleak, stent graft occlusion and migration; however, larger scale prospective studies are required to validate its impacts on patient outcomes and cost savings to the healthcare system.

The role and mechanism of epidermal growth factor receptor in hemodynamic induction of abdominal aortic aneurysm formation

“…Studies have confirmed that women with AAA have a higher risk of rupture than men, and smokers and those with untreated hypertension are also at increased risk (25)(26)(27). It is still a hot research topic to assess the specific rupture risk of patients with AAA by monitoring aneurysm volume, aortic size index (ratio of body surface area to aneurysm diameter), family history of (29,30) have shown that MMP-2 and MMP-9 are interdependent and synergistic in the progression of AAA. In addition to MMP-2 and MMP-9, whether other MMPs are involved in the pathogenesis of aneurysms should be further studied.…”

“…Further, MMP-2 can also shear elastin and type IV collagen. Studies ( 29 , 30 ) have shown that MMP-2 and MMP-9 are interdependent and synergistic in the progression of AAA. In addition to MMP-2 and MMP-9, whether other MMPs are involved in the pathogenesis of aneurysms should be further studied.…”

A Meta-Review about Medical 3D Printing

“…Yang and colleagues [87] mentioned the following pediatric surgical sub-specialties: neurosurgery, cardiothoracic Surgery, plastic Surgery, cardiovascular surgery, urological surgery, orthopedics, ENT surgery, oncological surgery and vascular surgery. Further medical fields include plastic surgery [93,94], traumatology [95][96][97], urology [98][99][100][101][102] and vascular surgery [103][104][105][106]. The affected organs or organ systems include the aorta [13,103,106], bladder [29], brain [35,37,39], cranium [30, 31, 34, 36, 44, 48-50, 53-55, 82, 84, 86, 91], ear [48, 78-81, 83, 93], female internal genitals [46], heart [2-12, 87, 88, 104], jaw [17, 20, 21, 23, 25, 47-52, 55, 56], kidney [29,41,98,[100][101][102], lip [94], liver [19,22,28], musculoskeletal system [20, 21, 24, 31-33, 38, 43, 57-77, 89, 90, 92, 93, 95-97], prostate [98,99], rectum and colon [14,40,42,45], spine…”

“…Yang and colleagues [87] mentioned the following pediatric surgical sub-specialties: neurosurgery, cardiothoracic Surgery, plastic Surgery, cardiovascular surgery, urological surgery, orthopedics, ENT surgery, oncological surgery and vascular surgery. Further medical fields include plastic surgery [93, 94], traumatology [95–97], urology [98–102] and vascular surgery [103–106].…”

3D printed patient-specific prostate cancer models to guide nerve-sparing robot-assisted radical prostatectomy: a systematic review

“…As the technology has entered the mainstream consciousness, Urologists have capitalised on its strengths to 3D print anatomical models within the hospital environment [ 2 , 3 ]. The technology allows for the creation of patient-specific models for visual and tactile interrogation, positioning it as a natural adjunct for complex cases where adequate visualisation of each patient’s unique anatomy is paramount [ 4 ].…”