Three-Dimensional Printing to Guide the Application of Modified Prefenestrated Stent Grafts to Treat Aortic Arch Disease

Background: The aim of this study was to summarize the experience and outcomes of total endovascular repair of aortic arch disease using three-dimensional (3D) printing to guide the application of modified prefenestrated/branched stent grafts.Patients and methods: From April 2018 to March 2019, 17 patients with aortic arch disease were treated in our department. Five patients had an aortic arch aneurysm and 12 had undergone an aortic arch dissection. Thirteen men and 4 were women, with an average age of 57.82 +/- 10.47 years. Preoperatively, a 3D-printed model of the aorta was made according to computed tomography data. Then, under the guidance of the 3D- printed aortic model, modified prefenestrated/branched stent grafts were prepared, and the diameter of the stent grafts was reduced intraoperatively by a physician for total endovascular repair. Aortic computed tomography angiography was performed 3 and 6 months after the surgery.Results: All procedures were completed in one stage with no conversions to sternotomy. Among all 17 patients, the operation was successful in 16. One patient was treated with a chimney graft and a stent graft fenestrated in situ because of distortion of the stent. The success rate of the technique was 94.18%. The average operation time was 4.18 +/- 1.57 hr, and no patients died. No neurologic complications, such as cerebral infarction or paraplegia, were observed during the follow-up period.Conclusions: Three-Dimensional printing can be used to help guide the treatment of aortic arch disease using modified prefenestrated/branched stent grafts. This minimally invasive total treatment technique is accurate, allows quick recovery, and has a low complication rate. The short-term follow-up data show the safety and reliability of the method; however, further research and development are needed.

背景：本研究旨在总结应用三维（3D）打印引导改良预开窗/分支覆膜支架在主动脉弓疾病全腔内修复中的经验及结果。 患者与方法：2018年4月至2019年3月，我科收治17例主动脉弓疾病患者。其中5例为主动脉弓动脉瘤，12例为主动脉弓夹层。男性13例，女性4例，平均年龄57.82±10.47岁。术前根据计算机断层扫描数据制作主动脉3D打印模型。然后，在3D打印主动脉模型的引导下，制备改良预开窗/分支覆膜支架，术中由医生缩小支架直径以进行全腔内修复。术后3个月和6个月进行主动脉计算机断层血管造影检查。 结果：所有手术均一期完成，无中转开胸病例。17例患者中，16例手术成功。1例因支架扭曲采用烟囱支架及原位开窗支架治疗。技术成功率为94.18%。平均手术时间为4.18±1.57小时，无患者死亡。随访期间未观察到脑梗死或截瘫等神经系统并发症。 结论：三维打印可用于辅助引导改良预开窗/分支覆膜支架治疗主动脉弓疾病。这种微创的整体治疗技术准确，恢复快，并发症发生率低。短期随访数据表明该方法安全可靠，但仍需进一步研究和发展。