Three-dimensional printing technique to guide the application of customized fenestrated stent grafts in aortic arch disease

Objective To summarize the experience and outcomes of the total endovascular repair of aortic arch disease using three-dimensional (3D) printing to guide the application of customized fenestrated/branched stent grafts technique. Methods From February 2018 to October 2018, 12 patients with aortic arch disease were treated in our department. There were 4 patients with aortic arch aneurysm and 8 with aortic arch dissection. There were 10 males and 2 females, with age of (60.17±13.32) years. Preoperatively, a 3D printed model of the aorta was made according to CT images. Then, under the guidance of the 3D printed aortic model, fenestrated/branched stent grafts were customized and the diameter of stent grafts were reduced intraoperatively by a physician for total endovascular repair. Aorta computed tomography angiography(CTA) was performed 3 and 6 months after surgery. Results All procedures were completed in one stage with no conversions. Of all 12 patients, 11 of patients were successfully operated. One patient was treated by Chimney graft and in-situ fenestrated stent graft technique because of the distortion of the stent. The success rate of the technique was 91.67%(11/12). The operation time was (4.38±1.67) h, no patient died. No neurological complications like cerebral infarction or paraplegia were observed during the follow-up. Conclusion 3D printing could be used to help guide the treatment of aortic arch disease using customized fenestrated/ branched stent grafts. This minimally invasive treatment technique is more accurate, more advanced in quick recovery and has low incidence of complications. The short-term follow-up data show the safety and reliability of the procedure; however, further research and development are needed. Key words: Three-dimensional printing; Aortic arch; Fenestrated stent graft; Endovascular aortic repair