3dMedLab, Austin Health, The University of Melbourne, Parkville, Australia; Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Australia.
Department of Engineering, University of New South Wales, Kensington, Australia.
J Vasc Surg. 2021 Jul;74(1):296-306.e1. doi: 10.1016/j.jvs.2020.08.158. Epub 2021 Mar 4.
Fenestrated endovascular aneurysm repair has yet to gain widespread adoption owing to the technical complexity and increased risk of complications. Three-dimensional (3D) printed templates to guide fenestrated physician-modified stent grafts (PMSGs) are a novel technique that may have the potential to increase the accuracy of fenestration alignment, and to disrupt both the cost and timing of the current commercial fenestrated endograft supply chain. We have conducted a critical appraisal of the emerging literature to assess this.
A systematic literature search was performed using PubMed and OVID Medline as guided by the PRISMA statement on April 30, 2020. We used "3D printing" and "physician modified" or "surgeon modified" and all related search terms. We identified 50 articles which met our search criteria. None articles were included as being of direct relevance to 3D-printed template-assisted PMSGs for fenestrated endovascular aneurysm repair. Abstracts were screened individually by each investigator to ensure relevance.
Nine relevant articles were identified for critical analysis. These included one technical report, five case reports or series, two prospective trials, and one letter to the editor.
These 3D-printed templates are a promising new avenue to assist with the placement of fenestrations in PMSGs, particularly in urgent or emergent cases where custom fenestrated endografts are unavailable, with larger scale studies warranted. Further work to validate the key stages of the template workflow are required, as well as further investigation into the most suitable manufacturing and distribution methods before the mainstream implementation of this novel technique.
由于技术复杂性和并发症风险增加，血管内动脉瘤修复的开窗技术尚未得到广泛应用。三维（3D）打印模板可指导医生修改的开窗支架移植物（PMSG），这是一种新的技术，有可能提高开窗的准确性，并打破当前商业开窗血管内移植物供应链的成本和时间限制。我们对新兴文献进行了批判性评估，以评估这种技术。
根据 PRISMA 声明，我们于 2020 年 4 月 30 日在 PubMed 和 OVID Medline 上进行了系统的文献检索。我们使用了“3D 打印”和“医生修改”或“外科医生修改”以及所有相关的搜索词。我们确定了 50 篇符合我们搜索标准的文章。没有一篇文章被直接认为与用于血管内动脉瘤修复的开窗支架移植物的 3D 打印模板辅助有关。每个研究人员单独筛选摘要以确保相关性。
确定了 9 篇相关文章进行批判性分析。其中包括一份技术报告、五份病例报告或系列报告、两份前瞻性试验和一份给编辑的信。
这些 3D 打印模板是一种有前途的新技术，可用于辅助 PMSG 中的开窗，特别是在紧急或紧急情况下，无法使用定制的开窗血管内移植物时，需要进行更大规模的研究。需要进一步验证模板工作流程的关键阶段，以及进一步研究最适合的制造和分配方法，然后才能广泛实施这项新技术。
