Effectiveness of endovascular repair with fenestration stent and branch stent assisted by 3D printing in treating thoracoabdominal aortic aneurysm involving visceral artery area_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 SUN Yan ¹ , WANG Yutao ² , ZHANG Shiyi ¹ , DONG Dianning ¹ , WU Xuejun ¹

1. Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P.R.China;
2. Department of Peripheral Vascular Disease, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, 250012, P.R.China;

Corresponding?author：

SUN Yan, Email: sdxueguan@163.com

Keywords：

3D printing; endovascular repair; aortic aneurysm; fenestration stent; branch stent

DOI：

10.7507/1007-4848.202007014

Video：

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Objective To evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3D printing.Methods The clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively. There were 5 males and 2 females with an average age of 70.2±3.9 years. Among them 4 patients had near-renal abdominal aortic aneurysm, 3 had thoracic aortic aneurysm, 4 had asymptomatic aneurysm, 2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm. According to the preoperative CT measurement and 3D printing model, fenestration technique was used with Cook Zenith thoracic aortic stents, and branch stents were sewed on the main stents in vitro, and then the stents were modified by beam diameter technique for intracavitary treatment.Results All the 7 patients completed the operation successfully, and a total of 18 branch arteries were reconstructed. The success rate of surgical instrument release was 100.0%. The average operation time was 267.0±38.5 min, the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d. Immediate intraoperative angiography showed that the aneurysms were isolated, and the visceral arteries were unobstructed. Till May 2019, there was no death, stent displacement, stent occlusion, ruptured aneurysm or loss of visceral artery branches. Conclusion 3D printing technology can completely copy the shape of human artery, intuitively present the anatomical structure and position of each branch of the artery, so that the fenestration technique is more accurate and the treatment scheme is more optimized.

Citation： SUN Yan, WANG Yutao, ZHANG Shiyi, DONG Dianning, WU Xuejun. Effectiveness of endovascular repair with fenestration stent and branch stent assisted by 3D printing in treating thoracoabdominal aortic aneurysm involving visceral artery area. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 90-94. doi: 10.7507/1007-4848.202007014 Copy

1.	Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg, 2007, 83(2): S862-S864.
2.	依地熱斯·艾山, 李新喜, 田野, 等. 開窗支架與煙囪技術腔內治療腹主動脈瘤療效比較的 Meta 分析. 中國普通外科雜志, 2019, 28(6): 696-705.
3.	朱杰昌, 胡凡果, 張益偉, 等. 臺上體外開窗腔內動脈瘤修復術治療短瘤頸腹主動脈瘤的初步觀察. 中華醫學雜志, 2016, 96(45): 3642-3646.
4.	Cross J, Gurusamy K, Gadhvi V, et al. Fenestrated endovascular aneurysm repair. Br J Surg, 2012, 99(2): 152-159.
5.	Nordon IM, Hinchliffe RJ, Holt PJ, et al. Modern treatment of juxtarenal abdominal aortic aneurysms with fenestrated endografting and open repair—A systematic review. Eur J Vasc Endovasc Surg, 2009, 38(1): 35-41.
6.	Oderich GS, Correa MP, Mendes BC. Technical aspects of repair of juxtarenal abdominal aortic aneurysms using the Zenith fenestrated endovascular stent graft. J Vasc Surg, 2014, 59(5): 1456-1461.
7.	Kim GB, Lee S, Kim H, et al. Three-dimensional printing: Basic principles and applications in medicine and radiology. Korean J Radiol, 2016, 17(2): 182-197.
8.	劉昭, 童垣皓, 于同, 等. 3D 打印引導下采用開窗或分支支架治療胸腹主動脈疾病. 中華普通外科雜志, 2019, 34(3): 213-216.
9.	Barón V, Guevara R. Three-dimensional printing-guided fenestrated endovascular aortic aneurysm repair using open source software and physician-modified devices. J Vasc Surg Cases Innov Tech, 2019, 5(4): 566-571.
10.	袁丁, 左蕭, 黃斌, 等. 3D 打印技術輔助復雜瘤頸腹主動脈瘤腔內治療: 附1例報道. 中國普外基礎與臨床雜志, 2015, 22(1): 96-98.
11.	劉長建, 劉昭. 3D 打印技術引導預開窗治療復雜主動脈弓部病變. 中國實用外科雜志, 2018, 38(12): 1381-1384.
12.	陳巖, 朱杰昌, 戴向晨, 等. 臺上體外開窗技術治療胸腹主動脈病變. 中華普通外科雜志, 2018, 33(3): 196-200.
13.	Blankensteijn LL, Dijkstra ML, Tielliu IF, et al. Midterm results of the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. J Vasc Surg, 2017, 65(2): 303-310.
14.	朱杰昌, 戴向晨, 羅宇東, 等. 體外開窗腔內主動脈修復術治療胸腹主動脈病變的早期結果分析. 中華醫學雜志, 2018, 98(12): 921-925.
15.	Banno H, Cochennec F, Marzelle J, et al. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg, 2014, 60(1): 31-39.
16.	Donas KP, Bisdas T, Austermann M, et al. The chimney technique has a complementary role in the endovascular repair of juxtarenal aortic aneurysms: There is no need for a paradigm shift but for accurate patient selection. J Endovasc Ther, 2013, 20(4): 584-587.
17.	Verhoeven EL, Vourliotakis G, Bos WT, et al. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: An 8-year single-centre experience. Eur J Vasc Endovasc Surg, 2010, 39(5): 529-536.
18.	Greenberg RK, Sternbergh WC, Makaroun M, et al. Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg, 2009, 50(4): 730-737.
19.	Verhoeven EL, Tielliu IF, Bos WT, et al. Present and future of branched stent grafts in thoraco-abdominal aortic aneurysm repair: A single-centre experience. Eur J Vasc Endovasc Surg, 2009, 38(2): 155-161.

1. Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg, 2007, 83(2): S862-S864.
2. 依地熱斯·艾山, 李新喜, 田野, 等. 開窗支架與煙囪技術腔內治療腹主動脈瘤療效比較的 Meta 分析. 中國普通外科雜志, 2019, 28(6): 696-705.
3. 朱杰昌, 胡凡果, 張益偉, 等. 臺上體外開窗腔內動脈瘤修復術治療短瘤頸腹主動脈瘤的初步觀察. 中華醫學雜志, 2016, 96(45): 3642-3646.
4. Cross J, Gurusamy K, Gadhvi V, et al. Fenestrated endovascular aneurysm repair. Br J Surg, 2012, 99(2): 152-159.
5. Nordon IM, Hinchliffe RJ, Holt PJ, et al. Modern treatment of juxtarenal abdominal aortic aneurysms with fenestrated endografting and open repair—A systematic review. Eur J Vasc Endovasc Surg, 2009, 38(1): 35-41.
6. Oderich GS, Correa MP, Mendes BC. Technical aspects of repair of juxtarenal abdominal aortic aneurysms using the Zenith fenestrated endovascular stent graft. J Vasc Surg, 2014, 59(5): 1456-1461.
7. Kim GB, Lee S, Kim H, et al. Three-dimensional printing: Basic principles and applications in medicine and radiology. Korean J Radiol, 2016, 17(2): 182-197.
8. 劉昭, 童垣皓, 于同, 等. 3D 打印引導下采用開窗或分支支架治療胸腹主動脈疾病. 中華普通外科雜志, 2019, 34(3): 213-216.
9. Barón V, Guevara R. Three-dimensional printing-guided fenestrated endovascular aortic aneurysm repair using open source software and physician-modified devices. J Vasc Surg Cases Innov Tech, 2019, 5(4): 566-571.
10. 袁丁, 左蕭, 黃斌, 等. 3D 打印技術輔助復雜瘤頸腹主動脈瘤腔內治療: 附1例報道. 中國普外基礎與臨床雜志, 2015, 22(1): 96-98.
11. 劉長建, 劉昭. 3D 打印技術引導預開窗治療復雜主動脈弓部病變. 中國實用外科雜志, 2018, 38(12): 1381-1384.
12. 陳巖, 朱杰昌, 戴向晨, 等. 臺上體外開窗技術治療胸腹主動脈病變. 中華普通外科雜志, 2018, 33(3): 196-200.
13. Blankensteijn LL, Dijkstra ML, Tielliu IF, et al. Midterm results of the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. J Vasc Surg, 2017, 65(2): 303-310.
14. 朱杰昌, 戴向晨, 羅宇東, 等. 體外開窗腔內主動脈修復術治療胸腹主動脈病變的早期結果分析. 中華醫學雜志, 2018, 98(12): 921-925.
15. Banno H, Cochennec F, Marzelle J, et al. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg, 2014, 60(1): 31-39.
16. Donas KP, Bisdas T, Austermann M, et al. The chimney technique has a complementary role in the endovascular repair of juxtarenal aortic aneurysms: There is no need for a paradigm shift but for accurate patient selection. J Endovasc Ther, 2013, 20(4): 584-587.
17. Verhoeven EL, Vourliotakis G, Bos WT, et al. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: An 8-year single-centre experience. Eur J Vasc Endovasc Surg, 2010, 39(5): 529-536.
18. Greenberg RK, Sternbergh WC, Makaroun M, et al. Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg, 2009, 50(4): 730-737.
19. Verhoeven EL, Tielliu IF, Bos WT, et al. Present and future of branched stent grafts in thoraco-abdominal aortic aneurysm repair: A single-centre experience. Eur J Vasc Endovasc Surg, 2009, 38(2): 155-161.

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Effectiveness of endovascular repair with fenestration stent and branch stent assisted by 3D printing in treating thoracoabdominal aortic aneurysm involving visceral artery area

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