Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA 19130 USA.
J Invasive Cardiol. 2022 Jun;34(6):E455-E461. doi: 10.25270/jic/21.00310.
Three-dimensional (3D) printing for subclavian artery (SA) percutaneous vascular interventions (PVI) may allow superior understanding of patient specific complex anatomy and aid with preprocedural planning.
Five patients with computed tomography angiography (CTA) of the neck who underwent SA PVI were queried retrospectively. 3D printing of aortic arch and great vessels was accomplished with 3D slicer software and painted with acrylic paint to highlight anatomic features. The aortic arch type and implications for preprocedural planning for SA interventions including complex chronic total occlusion (CTO) lesions were determined. Comparisons were made with SA angiograms and 3D-CTA.
Of the 5 patients, type I (n = 2), type II (n = 1), and type III (n = 2) aortic arches were identified. Proximal and distal reference vessel size and total lesion length were determined using a digital millimeter caliper and correlated with intraprocedural balloons and stents. In 3D-printed models (3D-PMs) of patients with SA-CTO (n = 2), cap morphology (tapered vs blunt) and distal vessel filling were visualized, permitting optimal arterial access site selection for successful cap crossing. The vertebral arteries (VAs) were also 3D printed which further allowed the ability to delineate optimal stent deployment site (proximal or distal to VA), a common dilemma that is faced intraprocedurally. The 3D-PMs also allowed preprocedural precision in stent and balloon size and length, potentially leading to procedural efficiency and cost-effectiveness.
3D printing of aortic arch and great vessel anatomy for SA-PVI allows multiple procedure-related factors to be predicted in advance, translating to decrease in contrast volume, radiation time, procedure and fluoroscopic time, thereby improving procedure and cost efficiency.
经皮血管介入（PVI）治疗锁骨下动脉（SA）时的三维（3D）打印可使患者特定的复杂解剖结构更好地理解，并有助于术前规划。
回顾性检索了 5 例接受颈部 CT 血管造影（CTA）检查并行 SA PVI 的患者。使用 3D slicer 软件对主动脉弓和大血管进行 3D 打印，并使用丙烯酸漆进行绘画，以突出解剖特征。确定主动脉弓类型以及对 SA 介入术包括复杂慢性完全闭塞（CTO）病变的术前规划的影响。与 SA 血管造影和 3D-CTA 进行比较。
5 例患者中，确定了 1 例 1 型（n=2）、1 例 2 型和 2 例 3 型主动脉弓。使用数字毫米卡尺确定近端和远端参考血管大小和总病变长度，并与术中球囊和支架相吻合。在 2 例 SA-CTO 患者的 3D-PM 中（n=2），观察到帽形态（锥形与钝形）和远端血管充盈情况，从而为成功帽穿线选择最佳动脉入路。椎动脉（VA）也进行了 3D 打印，这进一步允许确定最佳支架放置部位（VA 近端或远端），这是术中常见的难题。3D-PM 还可以在术前精确地确定支架和球囊的大小和长度，从而可能提高手术效率和成本效益。
SA-PVI 主动脉弓和大血管解剖的 3D 打印可以提前预测多种与手术相关的因素，从而减少造影剂用量、辐射时间、手术和透视时间，从而提高手术效率和成本效益。
