Coles-Black Jasamine, Bolton Damien, Chuen Jason
3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia.
Department of Surgery, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.
Front Surg. 2021 Jan 27;7:626212. doi: 10.3389/fsurg.2020.626212. eCollection 2020.
3D printed patient-specific vascular phantoms provide superior anatomical insights for simulating complex endovascular procedures. Currently, lack of exposure to the technology poses a barrier for adoption. We offer an accessible, low-cost guide to producing vascular anatomical models using routine CT angiography, open source software packages and a variety of 3D printing technologies. Although applicable to all vascular territories, we illustrate our methodology using Abdominal Aortic Aneurysms (AAAs) due to the strong interest in this area. CT aortograms acquired as part of routine care were converted to representative patient-specific 3D models, and then printed using a variety of 3D printing technologies to assess their material suitability as aortic phantoms. Depending on the technology, phantoms cost $20-$1,000 and were produced in 12-48 h. This technique was used to generate hollow 3D printed thoracoabdominal aortas visible under fluoroscopy. 3D printed AAA phantoms were a valuable addition to standard CT angiogram reconstructions in the simulation of complex cases, such as short or very angulated necks, or for positioning fenestrations in juxtarenal aneurysms. Hollow flexible models were particularly useful for device selection and in planning of fenestrated EVAR. In addition, these models have demonstrated utility other settings, such as patient education and engagement, and trainee and anatomical education. Further study is required to establish a material with optimal cost, haptic and fluoroscopic fidelity. We share our experiences and methodology for developing inexpensive 3D printed vascular phantoms which despite material limitations, successfully mimic the procedural challenges encountered during live endovascular surgery. As the technology continues to improve, 3D printed vascular phantoms have the potential to disrupt how endovascular procedures are planned and taught.
3D打印的患者特异性血管模型为模拟复杂的血管内手术提供了卓越的解剖学见解。目前，缺乏对该技术的接触成为了采用它的障碍。我们提供了一份易于获取且低成本的指南，介绍如何使用常规CT血管造影、开源软件包和多种3D打印技术来制作血管解剖模型。尽管该方法适用于所有血管区域，但由于对腹主动脉瘤（AAA）领域的浓厚兴趣，我们以腹主动脉瘤为例来说明我们的方法。作为常规护理一部分获取的CT主动脉造影被转换为具有代表性的患者特异性3D模型，然后使用多种3D打印技术进行打印，以评估它们作为主动脉模型的材料适用性。根据技术不同，模型成本为20美元至1000美元，制作时间为12至48小时。该技术用于生成在荧光透视下可见的中空3D打印胸腹主动脉。在模拟复杂病例时，如短颈或角度非常大的颈部，或在肾周动脉瘤中定位开窗时，3D打印的AAA模型是标准CT血管造影重建的宝贵补充。中空的柔性模型对于器械选择和开窗式腔内血管修复术（EVAR）的规划特别有用。此外，这些模型已在其他场景中展示了其效用，如患者教育与参与以及实习生和解剖学教育。需要进一步研究以确定一种在成本、触觉和荧光透视保真度方面具有最佳表现的材料。我们分享了开发廉价3D打印血管模型的经验和方法，尽管存在材料限制，但这些模型成功地模拟了现场血管内手术中遇到的操作挑战。随着技术不断改进，3D打印血管模型有可能改变血管内手术的规划和教学方式。
