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Colacchio EC, Berton M, Volpe A, Guariento A, Dall'Antonia A, Antonello M. Three-Dimensional Printing Application in a Challenging Case of Type II Endoleak. J Endovasc Ther 2024; 31:474-478. [PMID: 36129167 DOI: 10.1177/15266028221124441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To highlight the importance of 3-dimensional (3D) arterial printing in a case of type II endoleak (EL) embolization. CASE REPORT An 81-year-old patient, previously treated with endovascular aortic repair (EVAR), developed a type II EL requiring treatment. The EL's main origin was the median sacral artery (MSA). Initial attempts in embolization via a transsealing and transarterial approach were unsuccessful owing to extremely tortuous arterial communications between the left hypogastric artery and the MSA. The construction of a clear resin 3D model of the aorta and iliolumbar arteries improved anatomy understanding and moreover allowed a preoperative simulation. The subsequent transarterial attempt in embolization was resolutive, significantly reducing total procedural time and radiation dose. CONCLUSION Printing of clear resin 3D arterial models facilitates type II EL transarterial embolization, improving anatomy understanding and allowing simple fluoroscopy-free simulations. CLINICAL IMPACT The aim of our work is to highlight the additional value of three-dimensional (3D) printing during preoperative planning of challenging endovascular cases. To our best knowledge, this is the first report about 3D printing use in a case of type II endoleak (EL). We believe that realizing life-size aortic models in selected cases where a complex type II EL embolization procedure is indicated, could lead to a better understanding of arterial anatomy, thus allowing to increase procedural success and reduce operative and most importantly fluoroscopy time.
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Affiliation(s)
- Elda Chiara Colacchio
- Vascular and Endovascular Surgery Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Mariagiovanna Berton
- Vascular and Endovascular Surgery Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Alberto Dall'Antonia
- Vascular and Endovascular Surgery Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Lee J, Chadalavada SC, Ghodadra A, Ali A, Arribas EM, Chepelev L, Ionita CN, Ravi P, Ryan JR, Santiago L, Wake N, Sheikh AM, Rybicki FJ, Ballard DH. Clinical situations for which 3D Printing is considered an appropriate representation or extension of data contained in a medical imaging examination: vascular conditions. 3D Print Med 2023; 9:34. [PMID: 38032479 PMCID: PMC10688120 DOI: 10.1186/s41205-023-00196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical three-dimensional (3D) printing has demonstrated utility and value in anatomic models for vascular conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (3DPSIG) provides appropriateness recommendations for vascular 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with vascular indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for the following areas: aneurysm, dissection, extremity vascular disease, other arterial diseases, acute venous thromboembolic disease, venous disorders, lymphedema, congenital vascular malformations, vascular trauma, vascular tumors, visceral vasculature for surgical planning, dialysis access, vascular research/development and modeling, and other vasculopathy. Recommendations are provided in accordance with strength of evidence of publications corresponding to each vascular condition combined with expert opinion from members of the 3DPSIG. CONCLUSION This consensus appropriateness ratings document, created by the members of the 3DPSIG, provides an updated reference for clinical standards of 3D printing for the care of patients with vascular conditions.
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Affiliation(s)
- Joonhyuk Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego Health, San Diego, CA, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Adnan M Sheikh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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Abstract
Microvasculature functions at the tissue and cell level, regulating local mass exchange of oxygen and nutrient-rich blood. While there has been considerable success in the biofabrication of large- and small-vessel replacements, functional microvasculature has been particularly challenging to engineer due to its size and complexity. Recently, three-dimensional bioprinting has expanded the possibilities of fabricating sophisticated microvascular systems by enabling precise spatiotemporal placement of cells and biomaterials based on computer-aided design. However, there are still significant challenges facing the development of printable biomaterials that promote robust formation and controlled 3D organization of microvascular networks. This review provides a thorough examination and critical evaluation of contemporary biomaterials and their specific roles in bioprinting microvasculature. We first provide an overview of bioprinting methods and techniques that enable the fabrication of microvessels. We then offer an in-depth critical analysis on the use of hydrogel bioinks for printing microvascularized constructs within the framework of current bioprinting modalities. We end with a review of recent applications of bioprinted microvasculature for disease modeling, drug testing, and tissue engineering, and conclude with an outlook on the challenges facing the evolution of biomaterials design for bioprinting microvasculature with physiological complexity.
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Affiliation(s)
- Ryan W. Barrs
- Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jia Jia
- Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Sophia E. Silver
- Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Michael Yost
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ying Mei
- Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC 29425, USA
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Sommer KN, Iyer V, Kumamaru KK, Rava RA, Ionita CN. Method to simulate distal flow resistance in coronary arteries in 3D printed patient specific coronary models. 3D Print Med 2020; 6:19. [PMID: 32761497 PMCID: PMC7410153 DOI: 10.1186/s41205-020-00072-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Three-dimensional printing (3DP) offers a unique opportunity to build flexible vascular patient-specific coronary models for device testing, treatment planning, and physiological simulations. By optimizing the 3DP design to replicate the geometrical and mechanical properties of healthy and diseased arteries, we may improve the relevance of using such models to simulate the hemodynamics of coronary disease. We developed a method to build 3DP patient specific coronary phantoms, which maintain a significant part of the coronary tree, while preserving geometrical accuracy of the atherosclerotic plaques and allows for an adjustable hydraulic resistance. METHODS Coronary computed tomography angiography (CCTA) data was used within Vitrea (Vital Images, Minnetonka, MN) cardiac analysis application for automatic segmentation of the aortic root, Left Anterior Descending (LAD), Left Circumflex (LCX), Right Coronary Artery (RCA), and calcifications. Stereolithographic (STL) files of the vasculature and calcium were imported into Autodesk Meshmixer for 3D model optimization. A base with three chambers was built and interfaced with the phantom to allow fluid collection and independent distal resistance adjustment of the RCA, LAD and LCX and branching arteries. For the 3DP we used Agilus for the arterial wall, VeroClear for the base and a Vero blend for the calcifications, respectively. Each chamber outlet allowed interface with catheters of varying lengths and diameters for simulation of hydraulic resistance of both normal and hyperemic coronary flow conditions. To demonstrate the manufacturing approach appropriateness, models were tested in flow experiments. RESULTS Models were used successfully in flow experiments to simulate normal and hyperemic flow conditions. The inherent mean resistance of the chamber for the LAD, LCX, and RCA, were 1671, 1820, and 591 (dynes ∙ sec/ cm5), respectively. This was negligible when compared with estimates in humans, with the chamber resistance equating to 0.65-5.86%, 1.23-6.86%, and 0.05-1.67% of the coronary resistance for the LAD, LCX, and RCA, respectively at varying flow rates and activity states. Therefore, the chamber served as a means to simulate the compliance of the distal coronary trees and to allow facile coupling with a set of known resistance catheters to simulate various physical activity levels. CONCLUSIONS We have developed a method to create complex 3D printed patient specific coronary models derived from CCTA, which allow adjustable distal capillary bed resistances. This manufacturing approach permits comprehensive coronary model development which may be used for physiologically relevant flow simulations.
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Affiliation(s)
- Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
| | - Vijay Iyer
- University at Buffalo Cardiology, University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | | | - Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA.
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA.
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Marti P, Lampus F, Benevento D, Setacci C. Trends in use of 3D printing in vascular surgery: a survey. INT ANGIOL 2019; 38:418-424. [PMID: 31560185 DOI: 10.23736/s0392-9590.19.04148-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of the following research was to provide a systematic survey on the use of additive manufacturing in vascular surgery. The survey focuses on applications of 3D printing in endovascular surgery like endovascular aneurysm repair (EVAR), a quite unexplored application domain. 3D printing is an additive production process of three-dimensional objects starting from a three-dimensional digital model. This kind of manufacturing process is getting great attention in the medical field and new applications have emerged in recent years especially thanks to the combination of additive printing with 3D imaging techniques. The purpose of the study is to reflect on additive manufacturing and its potential as an inclusive manufacturing practice which can provide benefits at economic and societal level. EVIDENCE ACQUISITION The article first introduces the use of 3D printing in surgery by summarizing the results of previous reviews which reveal three main usages of 3D printing: anatomic models, surgical tools, implants and prostheses. These studies point out that vascular surgery is still an unexplored field of application of 3D printing. Starting from this result, a new survey was carried out in databases Pubmed, Elsevier, Research Gate and ACM Digital Library for terms related to 3D printing in vascular surgery using the following keywords: 3D printing, vascular surgery, EVAR, aneurysm. The search screened articles published up to 2019 for relevance and practical application of the technology in vascular surgery, in particular the topic is related to the treatment of complex abdominal aortic aneurysm. EVIDENCE SYNTHESIS Initially 437 records published up to 2019 were found, but then were narrowed down to 29 full-text articles. The findings reveal that in addition to the applications found in the previous studies, new experiments are ongoing related to the use of 3D printing in the "Off label" practice to manually fenestrate the stent to improve the accuracy of the EVAR. CONCLUSIONS Different applications of the use of 3D printing and digital imaging in vascular surgery have been experimented with a different maturity level. Whilst the technology has increased its potential in the latest years, the number of studies documented in the literature is still quite narrow. Further research is necessary to fully test the potential of 3D printing, also in combination with other technologies (e.g. 3D imaging and CNC cutting). Early experimentations show that these technologies have the potential to radically change the vascular surgery practice in the near future, in particular in treatment like EVAR, to improve the planning and therefore the success of the surgery.
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Affiliation(s)
- Patrizia Marti
- Department of Social Political and Cognitive Science, University of Siena, Siena, Italy -
| | - Flavio Lampus
- Department of Social Political and Cognitive Science, University of Siena, Siena, Italy
| | | | - Carlo Setacci
- Department of Medical, Surgical Science and Neuroscience, University of Siena, Siena, Italy
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Li J, Chen Z, Yang X. State of the Art of Small-Diameter Vessel-Polyurethane Substitutes. Macromol Biosci 2019; 19:e1800482. [PMID: 30840365 DOI: 10.1002/mabi.201800482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/22/2019] [Indexed: 12/31/2022]
Abstract
Cardiovascular diseases are a severe threat to human health. Implantation of small-diameter vascular substitutes is a promising therapy in clinical operations. Polyurethane (PU) is considered one of the most suitable materials for this substitution due to its good mechanical properties, controlled biostability, and proper biocompatibility. According to biodegradability and biostability, in this review, PU small-diameter vascular substitutes are divided into two groups: biodegradable scaffolds and biostable prostheses, which are applied to the body for short- and long-term, respectively. Following this category, the degradation principles and mechanisms of different kinds of PUs are first discussed; then the chemical and physical methods for adjusting the properties and the research advances are summarized. On the basis of these discussions, the problems remaining at present are addressed, and the contour of future research and development of PU-based small-diameter vascular substitutes toward clinical applications is outlined.
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Affiliation(s)
- Jinge Li
- Polymer Composites Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, No. 5625 Renmin Ave., Changchun, 130022, China
| | - Zhaobin Chen
- Polymer Composites Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, No. 5625 Renmin Ave., Changchun, 130022, China
| | - Xiaoniu Yang
- State Key Laboratory of Polymer Physics and Chemistry, Polymer Composites Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, No. 5625 Renmin Ave., Changchun, 130022, China
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Tam CHA, Chan YC, Law Y, Cheng SWK. The Role of Three-Dimensional Printing in Contemporary Vascular and Endovascular Surgery: A Systematic Review. Ann Vasc Surg 2018; 53:243-254. [PMID: 30053547 DOI: 10.1016/j.avsg.2018.04.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/16/2018] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing, also known as rapid prototyping or additive manufacturing, is a novel adjunct in the medical field. The aim of this systematic review is to evaluate the role of 3D printing technology in the field of contemporary vascular surgery in terms of its technical aspect, practicability, and clinical outcome. METHODS A systematic search of literatures published from January 1, 1980 to July 15, 2017 was identified from the EMBASE, MEDLINE, and Cochrane library database with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The predefined selection inclusion criterion was clinical application of 3D printing technology in vascular surgery of large and small vessel pathology. RESULTS Forty-two articles were included in this systematic review, including 2 retrospective cohorts and 1 prospective case control study. 3D printing was mostly applied to abdominal aortic aneurysm (n = 20) and thoracic aorta pathology (n = 8), other vessels included celiac, splenic, carotid, subclavian, femoral artery, and portal vein (n = 10). The most commonly quoted materials were acrylonitrile-butadiene-styrene (n = 2), polylactic acid (n = 4), polyurethane resin (n = 3) and nylon (n = 3). The cost per replica ranged from USD $4-2,360. Cost for a commercial printer was around USD $2,210-50,000. CONCLUSION 3D printing was recognized and gradually incorporated as a useful adjunct in the field of vascular and endovascular surgery. The production of an accurate anatomic patient-specific replica was shown to bring significant impact in patient management in terms of anatomic understanding, procedural planning, and intraoperative navigation, education, and academic research as well as patient communication. Further analysis on cost-effectiveness was indicated to guide decisions on applicability of such promising technology on a routine basis.
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Affiliation(s)
- Chun Hei Adrian Tam
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Stephen Wing Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Chung M, Radacsi N, Robert C, McCarthy ED, Callanan A, Conlisk N, Hoskins PR, Koutsos V. On the optimization of low-cost FDM 3D printers for accurate replication of patient-specific abdominal aortic aneurysm geometry. 3D Print Med 2018; 4:2. [PMID: 29782613 PMCID: PMC5954792 DOI: 10.1186/s41205-017-0023-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/26/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is a potential for direct model manufacturing of abdominal aortic aneurysm (AAA) using 3D printing technique for generating flexible semi-transparent prototypes. A patient-specific AAA model was manufactured using fused deposition modelling (FDM) 3D printing technology. A flexible, semi-transparent thermoplastic polyurethane (TPU), called Cheetah Water (produced by Ninjatek, USA), was used as the flexible, transparent material for model manufacture with a hydrophilic support structure 3D printed with polyvinyl alcohol (PVA). Printing parameters were investigated to evaluate their effect on 3D-printing precision and transparency of the final model. ISO standard tear resistance tests were carried out on Ninjatek Cheetah specimens for a comparison of tear strength with silicone rubbers. RESULTS It was found that an increase in printing speed decreased printing accuracy, whilst using an infill percentage of 100% and printing nozzle temperature of 255 °C produced the most transparent results. The model had fair transparency, allowing external inspection of model inserts such as stent grafts, and good flexibility with an overall discrepancy between CAD and physical model average wall thicknesses of 0.05 mm (2.5% thicker than the CAD model). The tear resistance test found Ninjatek Cheetah TPU to have an average tear resistance of 83 kN/m, higher than any of the silicone rubbers used in previous AAA model manufacture. The model had lower cost (4.50 GBP per model), shorter manufacturing time (25 h 3 min) and an acceptable level of accuracy (2.61% error) compared to other methods. CONCLUSIONS It was concluded that the model would be of use in endovascular aneurysm repair planning and education, particularly for practicing placement of hooked or barbed stents, due to the model's balance of flexibility, transparency, robustness and cost-effectiveness.
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Affiliation(s)
- Michael Chung
- The School of Engineering, Institute for Materials and Processes, The University of Edinburgh, Robert Stevenson Road, Edinburgh, EH9 3FB UK
| | - Norbert Radacsi
- The School of Engineering, Institute for Materials and Processes, The University of Edinburgh, Robert Stevenson Road, Edinburgh, EH9 3FB UK
| | - Colin Robert
- The School of Engineering, Institute for Materials and Processes, The University of Edinburgh, Robert Stevenson Road, Edinburgh, EH9 3FB UK
| | - Edward D. McCarthy
- The School of Engineering, Institute for Materials and Processes, The University of Edinburgh, Robert Stevenson Road, Edinburgh, EH9 3FB UK
| | - Anthony Callanan
- The School of Engineering, Institute for Bioengineering, The University of Edinburgh, Max Born Crescent, Edinburgh, EH9 3FB UK
| | - Noel Conlisk
- The School of Engineering, Institute for Bioengineering, The University of Edinburgh, Max Born Crescent, Edinburgh, EH9 3FB UK
- Centre for Cardiovascular Sciences, The University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Peter R. Hoskins
- The School of Engineering, Institute for Bioengineering, The University of Edinburgh, Max Born Crescent, Edinburgh, EH9 3FB UK
- Centre for Cardiovascular Sciences, The University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Vasileios Koutsos
- The School of Engineering, Institute for Materials and Processes, The University of Edinburgh, Robert Stevenson Road, Edinburgh, EH9 3FB UK
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11
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Thompson A, McNally D, Maskery I, Leach RK. X-ray computed tomography and additive manufacturing in medicine: a review. INTERNATIONAL JOURNAL OF METROLOGY AND QUALITY ENGINEERING 2017. [DOI: 10.1051/ijmqe/2017015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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12
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Meess KM, Izzo RL, Dryjski ML, Curl RE, Harris LM, Springer M, Siddiqui AH, Rudin S, Ionita CN. 3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017. [PMID: 28638171 DOI: 10.1117/12.2253902] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. RESULTS With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. CONCLUSIONS With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.
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Affiliation(s)
- Karen M Meess
- The Jacobs Institute, Buffalo, NY 14203.,CUBRC Inc., Buffalo, NY 14225.,Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
| | - Richard L Izzo
- The Jacobs Institute, Buffalo, NY 14203.,Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
| | - Maciej L Dryjski
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Richard E Curl
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | | | - Adnan H Siddiqui
- The Jacobs Institute, Buffalo, NY 14203.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Stephen Rudin
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203.,Department of Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
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13
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Matsumoto JS, Morris JM, Foley TA, Williamson EE, Leng S, McGee KP, Kuhlmann JL, Nesberg LE, Vrtiska TJ. Three-dimensional Physical Modeling: Applications and Experience at Mayo Clinic. Radiographics 2016; 35:1989-2006. [PMID: 26562234 DOI: 10.1148/rg.2015140260] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiologists will be at the center of the rapid technologic expansion of three-dimensional (3D) printing of medical models, as accurate models depend on well-planned, high-quality imaging studies. This article outlines the available technology and the processes necessary to create 3D models from the radiologist's perspective. We review the published medical literature regarding the use of 3D models in various surgical practices and share our experience in creating a hospital-based three-dimensional printing laboratory to aid in the planning of complex surgeries.
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Affiliation(s)
- Jane S Matsumoto
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan M Morris
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Thomas A Foley
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Eric E Williamson
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Shuai Leng
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Kiaran P McGee
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Joel L Kuhlmann
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Linda E Nesberg
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Terri J Vrtiska
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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14
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Hossien A, Gelsomino S, Maessen J, Autschbach R. The Interactive Use of Multi-Dimensional Modeling and 3D Printing in Preplanning of Type A Aortic Dissection. J Card Surg 2016; 31:441-5. [PMID: 27251467 DOI: 10.1111/jocs.12772] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a technique of multidimensional modeling and 3D printing in preplanning of Type A acute aortic dissection (TAAD) repair. doi: 10.1111/jocs.12772 (J Card Surg 2016;31:441-445).
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Affiliation(s)
- Abdullrazak Hossien
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Germany.,Department of Cardiothoracic Surgery, Maastricht University Medical Centre, The Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, The Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, The Netherlands
| | - Rüdiger Autschbach
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Germany
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15
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Tam MD, Latham TR, Lewis M, Khanna K, Zaman A, Parker M, Grunwald IQ. A Pilot Study Assessing the Impact of 3-D Printed Models of Aortic Aneurysms on Management Decisions in EVAR Planning. Vasc Endovascular Surg 2016; 50:4-9. [DOI: 10.1177/1538574415623651] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Endovascular repair of aortic aneurysms with difficult anatomy is challenging. There is no consensus for planning such procedures. Methods: Six cases of aortic aneurysms with challenging anatomical features, such as short, angulated, and conical necks and tortuous iliacs were harvested. The computed tomography (CT) scans were anonymized. Lifesize 3-dimensional (3-D) printed models were created of the lumen. Endovascular operators were asked to review the CT angiography (CTA), make a management plan, and give an indication of their confidence. They were then presented with the equivalent model and asked to review their decision. Their attitudes to such models were briefly surveyed. Results: A total of 28 endovascular operators reviewed 144 cases. After review of the physical model, the management plan changed in 29 (20.1%) of 144 cases. Initial plan after CTA review was endovascular 73.6%, open repair 22.9%, and second opinion 3.5%. After model review, this became endovascular 67.4%, open repair 19.4%, and second opinion 4.8%. Although the general trend was toward more open procedures, off-label techniques reduced from 19.4% to 15.2% following model review. When the management plan did not change, level of confidence did increase in 37 (43.5%) of 85 cases. The majority of operators stated that they would find models useful for planning in some procedures. For 1 case, the change in the percentage of participants being sure in the management plan was statistically significant ( P = .031). Conclusion: The 3-D printed models may be potentially useful in planning cases with EVAR. It is a paradigm that warrants further investigation.
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Affiliation(s)
- Matthew D. Tam
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
| | - Tom R. Latham
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
| | - Mark Lewis
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Kunal Khanna
- Department of Radiology, St. Bartholomew’s and the Royal London NHS Foundation Trust, London, United Kingdom
| | - Ali Zaman
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
| | - Mike Parker
- Neuroscience and Vascular Simulation Unit, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Iris Q. Grunwald
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
- Neuroscience and Vascular Simulation Unit, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
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16
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Hoffman A, Nitecki S, Karram T, Leiderman M, Kogan I, Yudkovsky G, Ofer A. Enlarged and Colored Enhanced 3D Printing of Renal Artery Aneurysms for Improved Imaging and Treatment Planning. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/wjcd.2016.61001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Tam MD, Latham T, Brown JRI, Jakeways M. Use of a 3D printed hollow aortic model to assist EVAR planning in a case with complex neck anatomy: potential of 3D printing to improve patient outcome. J Endovasc Ther 2015; 21:760-2. [PMID: 25290807 DOI: 10.1583/14-4810l.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Matthew D Tam
- Departments of 1Radiology and 3Surgery, Southend University Hospital NHS Foundation Trust, Westcliff on Sea, UK 2Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK,
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18
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Tam MDBS, Laycock SD, Brown JRI, Jakeways M. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy. J Endovasc Ther 2014; 20:863-7. [PMID: 24325705 DOI: 10.1583/13-4450mr.1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). CASE REPORT A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. CONCLUSION Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.
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Affiliation(s)
- Matthew D B S Tam
- 1 Department of Radiology, Southend University Hospital NHS Foundation Trust, Westcliff on Sea, UK. 2Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
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19
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Allard L, Soulez G, Chayer B, Qin Z, Roy D, Cloutier G. A multimodality vascular imaging phantom of an abdominal aortic aneurysm with a visible thrombus. Med Phys 2014; 40:063701. [PMID: 23718616 DOI: 10.1118/1.4803497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE With the continuous development of new stent grafts and implantation techniques, it has now become technically feasible to treat abdominal aortic aneurysms (AAA) with challenging anatomy using endovascular repair with standard, fenestrated, or branched stent-grafts. In vitro experimentations are very useful to improve stent-graft design and conformability or imaging guidance for stent-graft delivery or follow-up. Vascular replicas also help to better understand the limitation of endovascular approaches in challenging anatomy and possibly improve surgical planning or training by practicing high risk clinical procedures in the laboratory to improve outcomes in the operating room. Most AAA phantoms available have a very basic anatomy, which is not representative of the clinical reality. This paper presents a method of fabrication of a realistic AAA phantom with a visible thrombus, as well as some mechanical properties characterizing such phantom. METHODS A realistic AAA geometry replica of a real patient anatomy taken from a multidetector computed tomography (CT) scan was manufactured. To demonstrate the multimodality imaging capability of this new phantom with a thrombus visible in magnetic resonance (MR) angiography, CT angiography (CTA), digital subtraction angiography (DSA), and ultrasound, image acquisitions with all these modalities were performed by using standard clinical protocols. Potential use of this phantom for stent deployment was also tested. A rheometer allowed defining hyperelastic and viscoelastic properties of phantom materials. RESULTS MR imaging measurements of SNR and CNR values on T1 and T2-weighted sequences and MR angiography indicated reasonable agreement with published values of AAA thrombus and abdominal components in vivo. X-ray absorption also lay within normal ranges of AAA patients and was representative of findings observed on CTA, fluoroscopy, and DSA. Ultrasound propagation speeds for developed materials were also in concordance with the literature for vascular and abdominal tissues. CONCLUSIONS The mimicked abdominal tissues, AAA wall, and surrounding thrombus were developed to match imaging features of in vivo MR, CT, and ultrasound examinations. This phantom should be of value for image calibration, segmentation, and testing of endovascular devices for AAA endovascular repair.
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Affiliation(s)
- Louise Allard
- Laboratory of Biorheology and Medical Ultrasonics, Research Center, University of Montreal Hospital (CRCHUM), Québec H2L 2W5, Canada
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Zenha H, Azevedo L, Rios L, Pinto A, Luz Barroso M, Cunha C, Costa H. The application of 3-D biomodeling technology in complex mandibular reconstruction—experience of 47 clinical cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0503-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Mao K, Wang Y, Xiao S, Liu Z, Zhang Y, Zhang X, Wang Z, Lu N, Shourong Z, Xifeng Z, Geng C, Baowei L. Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:797-802. [PMID: 20213294 DOI: 10.1007/s00586-010-1359-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 01/28/2010] [Accepted: 02/21/2010] [Indexed: 11/24/2022]
Abstract
Surgical treatment of complex severe spinal deformity, involving a scoliosis Cobb angle of more than 90 degrees and kyphosis or vertebral and rib deformity, is challenging. Preoperative two-dimensional images resulting from plain film radiography, computed tomography (CT) and magnetic resonance imaging provide limited morphometric information. Although the three-dimensional (3D) reconstruction CT with special software can view the stereo and rotate the spinal image on the screen, it cannot show the full-scale spine and cannot directly be used on the operation table. This study was conducted to investigate the application of computer-designed polystyrene models in the treatment of complex severe spinal deformity. The study involved 16 cases of complex severe spinal deformity treated in our hospital between 1 May 2004 and 31 December 2007; the mean +/- SD preoperative scoliosis Cobb angle was 118 degrees +/- 27 degrees. The CT scanning digital imaging and communication in medicine (DICOM) data sets of the affected spinal segments were collected for 3D digital reconstruction and rapid prototyping to prepare computer-designed polystyrene models, which were applied in the treatment of these cases. The computer-designed polystyrene models allowed 3D observation and measurement of the deformities directly, which helped the surgeon to perform morphological assessment and communicate with the patient and colleagues. Furthermore, the models also guided the choice and placement of pedicle screws. Moreover, the models were used to aid in virtual surgery and guide the actual surgical procedure. The mean +/- SD postoperative scoliosis Cobb angle was 42 degrees +/- 32 degrees, and no serious complications such as spinal cord or major vascular injury occurred. The use of computer-designed polystyrene models could provide more accurate morphometric information and facilitate surgical correction of complex severe spinal deformity.
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Affiliation(s)
- Keya Mao
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
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22
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Kalejs M, von Segesser LK. Rapid prototyping of compliant human aortic roots for assessment of valved stents. Interact Cardiovasc Thorac Surg 2008; 8:182-6. [PMID: 19036761 DOI: 10.1510/icvts.2008.194134] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adequate in-vitro training in valved stents deployment as well as testing of the latter devices requires compliant real-size models of the human aortic root. The casting methods utilized up to now are multi-step, time consuming and complicated. We pursued a goal of building a flexible 3D model in a single-step procedure. We created a precise 3D CAD model of a human aortic root using previously published anatomical and geometrical data and printed it using a novel rapid prototyping system developed by the Fab@Home project. As a material for 3D fabrication we used common house-hold silicone and afterwards dip-coated several models with dispersion silicone one or two times. To assess the production precision we compared the size of the final product with the CAD model. Compliance of the models was measured and compared with native porcine aortic root. Total fabrication time was 3 h and 20 min. Dip-coating one or two times with dispersion silicone if applied took one or two extra days, respectively. The error in dimensions of non-coated aortic root model compared to the CAD design was <3.0% along X, Y-axes and 4.1% along Z-axis. Compliance of a non-coated model as judged by the changes of radius values in the radial direction by 16.39% is significantly different (P<0.001) from native aortic tissue--23.54% at the pressure of 80-100 mmHg. Rapid prototyping of compliant, life-size anatomical models with the Fab@Home 3D printer is feasible--it is very quick compared to previous casting methods.
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Affiliation(s)
- Martins Kalejs
- Department of Cardio-Vascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Lausanne, Switzerland
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23
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Mazeyrat J, Romain O, Garda P, Lagrée PY, Destrade M, Karouia M, Leprince P. ENDOCOM : abdominal aortic aneurysm test bench for in vitro simulation. ACTA ACUST UNITED AC 2007; 2007:2323-6. [PMID: 18002457 DOI: 10.1109/iembs.2007.4352791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the aorta at the abdominal level, whose rupture is a life threatening complication. Recent treatment procedures of AAA consists in endovascular treatment with covered stent grafts. Despite improving design of these devices, this treatment is still associated with close to 25% of failure, due to persisting pressure into the excluded aneurysmal sac. The follow-up becomes thus crucial and demands frequent examinations (CT-scan, IRM) which are not so liable given the complications. In order to evaluate the post-operative period of an AAA treatment, we designed a communicative stent, comprising of an integrated pressure sensor. This paper presents the conception of a communicative sensor, the elaboration of a numerical model, and the development of an experimental testbench reproducing the aortic flux across an AAA and allowing the optimization and validation of the measurement principle.
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Affiliation(s)
- Johan Mazeyrat
- Université Pierre et Marie Curie, SYEL équipe d'acceuil 2385, Service de Chirurgie Thoracique et Cardio-Vasculaire, Paris, France
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24
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Neequaye SK, Aggarwal R, Van Herzeele I, Darzi A, Cheshire NJ. Endovascular skills training and assessment. J Vasc Surg 2007; 46:1055-64. [DOI: 10.1016/j.jvs.2007.05.041] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 05/20/2007] [Indexed: 10/22/2022]
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25
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Armillotta A, Bonhoeffer P, Dubini G, Ferragina S, Migliavacca F, Sala G, Schievano S. Use of rapid prototyping models in the planning of percutaneous pulmonary valved stent implantation. Proc Inst Mech Eng H 2007; 221:407-16. [PMID: 17605398 DOI: 10.1243/09544119jeim83] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Percutaneous replacement of the pulmonary valve is a recently developed inter-ventional technique which involves the implantation of a valved stent in the pulmonary trunk. It relies upon careful consideration of patient anatomy for both stent design and detailed procedure planning. Medical imaging data in the form of two-dimensional scans and three-dimensional interactive graphics offer only limited support for these tasks. The paper reports the results of an experimental investigation on the use of arterial models built by rapid prototyping techniques. An analysis of clinical needs has helped to specify proper requirements for such model properties as cost, strength, accuracy, elastic compliance, and optical transparency. Two different process chains, based on the fused deposition modelling technique and on the vacuum casting of thermoset resins in rubber moulds, have been tested for prototype fabrication. The use of anatomical models has allowed the cardiologist's confidence in patient selection, prosthesis fabrication, and final implantation to be significantly improved.
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Affiliation(s)
- A Armillotta
- Dipartimento di Meccanica, Politecnico di Milano, Milano, Italy.
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Smith CM, Stone AL, Parkhill RL, Stewart RL, Simpkins MW, Kachurin AM, Warren WL, Williams SK. Three-Dimensional BioAssembly Tool for Generating Viable Tissue-Engineered Constructs. ACTA ACUST UNITED AC 2004; 10:1566-76. [PMID: 15588416 DOI: 10.1089/ten.2004.10.1566] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The primary emphasis of tissue engineering is the design and fabrication of constructs for the replacement of nonfunctional tissue. Because tissue represents a highly organized interplay of cells and extracellular matrix, the fabrication of replacement tissue should mimic this spatial organization. This report details studies evaluating the use of a three-dimensional, direct-write cell deposition system to construct spatially organized viable structures. A direct-write bioassembly system was designed and fabricated to permit layer-by-layer placement of cells and extracellular matrix on a variety of material substrates. Human fibroblasts suspended in polyoxyethylene/polyoxypropylene were coextruded through a positive displacement pen delivery onto a polystyrene slide. After deposition, approximately 60% of the fibroblasts remained viable. Bovine aortic endothelial cells (BAECs) suspended in soluble collagen type I were coextruded via microdispense pen delivery onto the hydrophilic side of flat sheets of polyethylene terephthalate. After deposition with a 25-gauge tip, approximately 86% of the BAECs were viable. When maintained in culture for up to 35 days, the constructs remained viable and maintained their original spatial organization. These results indicate the potential for utilizing a direct-write, three-dimensional bioassembly tool to create viable, patterned tissue-engineered constructs.
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Affiliation(s)
- Cynthia M Smith
- Division of Biomedical Engineering, University of Arizona, Tucson, Arizona 85724-5084, USA
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Berry E, Marsden A, Dalgarno KW, Kessel D, Scott DJA. Flexible tubular replicas of abdominal aortic aneurysms. Proc Inst Mech Eng H 2002; 216:211-4. [PMID: 12137288 DOI: 10.1243/0954411021536423] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to manufacture life-size, flexible, tubular replicas of human abdominal aortic aneurysms and the associated vasculature, suitable for use in a training simulator for endovascular procedures. Selective laser sintering was used to create a geometrically correct master model for each of ten anatomical variations. The masters were used to generate flexible latex replicas. The use of the replicas in the training simulator was demonstrated. In total ten silicone rubber models were produced. When connected into the training simulator and perfused at arterial pressure it was possible to deploy an endovascular stent under fluoroscopic control and to perform angiography. The study has shown that conventional rapid prototyping technology can be used to manufacture flexible, radiolucent replicas which provide a realistic training environment for endovascular procedures.
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Affiliation(s)
- E Berry
- Centre of Medical Imaging Research and Academic Unit of Medical Physics, University of Leeds, UK
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