Perez Clara Isabel, Lakunza Lore, Saenz Alberto, Voces Roberto, Gallo Ignacio
Cardiac Surgery, Policlínica Gipuzkoa, Pº de Miramon 174, 20014 Donostia, Spain.
Multidisciplinary 3D Printing Platform, Biogipuzkoa Healthcare Investigation Institute, Pº Dr Begiristain, 20014 Donostia, Spain.
Eur Heart J Case Rep. 2025 Jul 30;9(8):ytaf362. doi: 10.1093/ehjcr/ytaf362. eCollection 2025 Aug.
Traumatic arteriovenous fistulas involving the thoracic aorta are rare. Their closure remains a challenge for the surgeon due to the vascular changes involved. We aim to highlight the benefits of 3D models and virtual three-dimensional reconstruction when used as a complementary tool in surgical planning.
We present the case of a 38-year-old male patient with a history trauma from a localized bombing, resulting in shrapnel impact to his thorax. He came for surgical treatment due to a diagnosis of arteriovenous fistula at the level of the aortic arch. For surgical planning, two 3D models (with FDM and PolyJet technology) were made to assess the anatomical relationship between the aorta, the left brachiocephalic vein, the fistulous tract and the sternum. The patient was successfully operated on.
Surgical repair of thoracic fistulas is highly complex, requiring a multi-disciplinary approach and advanced imaging for accurate diagnosis and planning. Procedures are often performed under cardiopulmonary bypass and hypothermia to enhance safety, especially in challenging scenarios. These fistulas frequently cause vascular overload and degenerative venous changes, increasing the risk of haemorrhage and complicating dissection. 3D technology significantly improves surgical planning by enabling accurate fistula localization, guiding sternotomy, simulating procedures, and mapping vascular anomalies. PolyJet models, in particular, provide superior anatomical insight. Thus, 3D modelling serves as a complementary tool that provides life-size, detailed anatomical information of the patient, facilitating better pre-operative surgical planning, and carrying the potential to reduce operative risks.
累及胸主动脉的创伤性动静脉瘘很少见。由于涉及血管变化，其闭合对外科医生来说仍然是一个挑战。我们旨在强调三维模型和虚拟三维重建在手术规划中作为辅助工具时的益处。
我们报告一例38岁男性患者，有局部爆炸伤史，导致胸部被弹片击中。因诊断为主动脉弓水平的动静脉瘘前来接受手术治疗。为进行手术规划，制作了两个三维模型（采用熔融沉积成型和PolyJet技术），以评估主动脉、左头臂静脉、瘘管和胸骨之间的解剖关系。患者手术成功。
胸瘘的手术修复非常复杂，需要多学科方法和先进成像技术以进行准确诊断和规划。手术通常在体外循环和低温下进行以提高安全性，尤其是在具有挑战性的情况下。这些瘘管常导致血管负荷过重和静脉退行性改变，增加出血风险并使解剖操作复杂化。三维技术通过实现瘘管准确定位、指导胸骨切开术、模拟手术和绘制血管异常情况，显著改善手术规划。特别是PolyJet模型能提供更优越的解剖学见解。因此，三维建模作为一种辅助工具，可提供患者真实大小、详细的解剖信息，有助于更好地进行术前手术规划，并有可能降低手术风险。
