Endovascular embolization techniques in acute thoracic and abdominal bleedings can be technically reproduced and trained in a standardized simulation setting using SLA 3D printing: a 1-year single-center study

Patient-specific vascular models for optimal catheter selection: Two aneurysm embolization cases

Patient-specific vascular models enhance preoperative planning in interventional radiology, particularly in complex and anatomically challenging cases. This report presents two cases of complex aneurysm coil embolization in which three-dimensional, printed, patient-specific vascular hollow models were key to selecting optimal catheters, leading to successful interventions. Preoperative simulations with these models facilitated preselection of the optimal catheter, minimizing the need for intraoperative catheter exchange and reducing the time required for catheter engagement and placement. This approach improves procedural efficiency and outcomes by ensuring a smoother workflow.

Effect of a Training System Utilizing 3-Dimensionally Printed Patient-Specific Vascular Models on Endovascular Catheterization Performance

This study aimed to determine the effect of simulation training using a 3-dimensionally (3D) printed patient-specific vascular model on the advanced vascular catheterization skills of experienced interventional radiologists. Two specific anatomical types of 3D-printed patient-specific models from 2 patients with challenging celiac axis arterial anatomy were constructed. The Global Rating Scale of Endovascular Performance (GRS-EP) was used to evaluate vascular insertion skills. The training sessions comprised pretraining and posttraining evaluations. Two blinded raters evaluated the effectiveness of the training. Improvements were observed in success rate, insertion time, and GRS-EP scores among all 5 experienced interventonial radiologists. The GRS-EP demonstrated high interrater reliability. Posttraining scores increased significantly in both video and self-evaluations. Although there is no proof that better performance on this type of model directly translates to improved performance in humans, simulation training using this model has the potential to help experienced interventional radiologists further refine their vascular catheterization skills.

In-House Fabrication and Validation of 3D-Printed Custom-Made Medical Devices for Planning and Simulation of Peripheral Endovascular Therapies

Objectives: This study aims to develop and validate a standardized methodology for creating high-fidelity, custom-made, patient-specific 3D-printed vascular models that serve as tools for preoperative planning and training in the endovascular treatment of peripheral artery disease (PAD). Methods: Ten custom-made 3D-printed vascular models were produced using computed tomography angiography (CTA) scans of ten patients diagnosed with PAD. CTA images were analyzed using Syngo.via by a specialist to formulate a medical prescription that guided the model's creation. The CTA data were then processed in OsiriX MD to generate the .STL file, which is further refined in a Meshmixer. Stereolithography (SLA) 3D printing technology was employed, utilizing either flexible or rigid materials. The dimensional accuracy of the models was evaluated by comparing their CT scan images with the corresponding patient data, using OsiriX MD. Additionally, both flexible and rigid models were evaluated by eight vascular surgeons during simulations in an in-house-designed setup, assessing both the technical aspects and operator perceptions of the simulation. Results: Each model took approximately 21.5 h to fabricate, costing €140 for flexible and €165 for rigid materials. Bland-Alman plots revealed a strong agreement between the 3D models and patient anatomy, with outliers ranging from 4.3% to 6.9%. Simulations showed that rigid models performed better in guidewire navigation and catheter stability, while flexible models offered improved transparency and lesion treatment. Surgeons confirmed the models' realism and utility. Conclusions: The study highlights the cost-efficient, high-fidelity production of 3D-printed vascular models, emphasizing their potential to enhance training and planning in endovascular surgery.

Systematic Review on the Use of 3D-Printed Models for Planning, Training and Simulation in Vascular Surgery

The use of 3D-printed models in simulation-based training and planning for vascular surgery is gaining interest. This study aims to provide an overview of the current applications of 3D-printing technologies in vascular surgery. We performed a systematic review by searching four databases: PubMed, Web of Science, Scopus, and Cochrane Library (last search: 1 March 2024). We included studies considering the treatment of vascular stenotic/occlusive or aneurysmal diseases. We included papers that reported the outcome of applications of 3D-printed models, excluding case reports or very limited case series (≤5 printed models or tests/simulations). Finally, 22 studies were included and analyzed. Computed tomography angiography (CTA) was the primary diagnostic method used to obtain the images serving as the basis for generating the 3D-printed models. Processing the CTA data involved the use of medical imaging software; 3DSlicer (Brigham and Women's Hospital, Harvard University, Boston, MA), ITK-Snap, and Mimics (Materialise NV, Leuven, Belgium) were the most frequently used. Autodesk Meshmixer (San Francisco, CA, USA) and 3-matic (Materialise NV, Leuven, Belgium) were the most frequently employed mesh-editing software during the post-processing phase. PolyJet™, fused deposition modeling (FDM), and stereolithography (SLA) were the most frequently employed 3D-printing technologies. Planning and training with 3D-printed models seem to enhance physicians' confidence and performance levels by up to 40% and lead to a reduction in the procedure time and contrast volume usage to varying extents.

Mechanical Properties of a 3 Dimensional-Printed Transparent Flexible Resin Used for Vascular Model Simulation Compared with Those of Porcine Arteries

PURPOSE

To develop a vascular intervention simulation model that replicates the characteristics of a human patient and to compare the mechanical properties of a 3-dimensional (3D)-printed transparent flexible resin with those of porcine arteries using the elastic modulus (E) and kinetic friction coefficient (μ_k).

MATERIALS AND METHODS

Resin plates were created from a transparent flexible resin using a 3D printer. Porcine artery plates were prepared by excising the aorta. E values and the adhesive strengths of the resin and arterial surfaces toward a polyethylene plate, were measured with a tensile-compressive mechanical tester. Resin transparency was measured using an ultraviolet-visible light spectrometer. The μ_k value of the resin plate surface after applying silicone spray for 1-5 seconds and that of the artery were measured using a translational friction tester.

RESULTS

E values differed significantly between the arteries and resin plates at each curing time (0.20 MPa ± 0.04 vs 8.53 MPa ± 2.37 for a curing time of 1 minute; P < .05). The resin was stiffer than the arteries, regardless of the curing times. The visible light transmittance and adhesive strength of the resin decreased as the curing time increased. The adhesive strength of the artery was the lowest. The μ_k value of the silicone-coated resin surface created by applying silicone for 2-3 seconds (thickness of the silicone layer, 1.6-2.0 μm) was comparable with that of the artery, indicating that the coating imparted a similar slippage to the resin as to the living artery.

CONCLUSIONS

A transparent flexible resin is useful for creating a transparent and slippery vascular model for vascular intervention simulation.

Usefulness of preoperative simulation with patient-specific hollow vascular models for high-flow renal arteriovenous fistula embolization using a preloading coil-in-plug technique

The development of three-dimensional printers has facilitated the creation of patient-specific hollow vessel models. Preoperative simulations using these types of models have improved our ability to select appropriate devices and embolic materials before performing complex endovascular procedures. This report describes 2 cases of high-flow renal arteriovenous fistulas (r-AVFs) that were successfully treated via short-segment embolization using the preloading coil-in-plug (p-CIP) technique. To our knowledge, this is the first report of r-AVF being treated using the p-CIP technique. Our findings demonstrate that preoperative simulation has the potential to improve the safety and reliability of complex vascular embolization procedures.