Skip to main content
SpringerLink
Log in

Simulation of Endovascular Aortic Repair Using 3D Printed Abdominal Aortic Aneurysm Model and Fluid Pump

  • Laboratory Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Background

Abdominal aortic aneurysm (AAA) models can be manufactured with 3D printing technology. This study describes detailed methodology and validation of endovascular aortic repair (EVAR) simulation using 3D printed AAA model connected to hemodynamic pump.

Method

The AAA model was printed with Objet500 Connex3 (Stratasys, Eden Prairie, MN) and connected to BDC PD-0500 fluid pump (BDC Laboratories, Wheat Ridge, CO). EVAR procedure metrics were benchmarked in two expert implanters and compared to 20 vascular surgical trainees with different levels of EVAR experience (< 20 or ≥ 20 cases). All simulations were performed using commercially available stent grafts, guidewires, catheters, fluoroscopic guidance and digital subtraction angiography. Studied outcomes included ability to complete the procedure independently, time to deploy aortic component, ability to cannulate contralateral gate and complete the repair, and total fluoroscopy and procedure times.

Results

A total of 22 EVAR simulation procedures were performed with mean procedure time of 37 ± 12 min. Experienced trainees had significantly lower total procedural time (32 ± 9 vs. 44 ± 6 min, P = 0.003) and fluoroscopic time (13 ± 5 vs. 23 ± 8 min, P = 0.005). All experienced trainees completed the procedure independently in < 45 min, compared to six (46%) of those with less EVAR experience (P = 0.016). Among less experienced trainees, only two (15%) completed the entire procedure independently (P < 0.001). Benchmark implanters performed significantly better than both trainee groups in nearly all EVAR metrics.

Conclusion

EVAR simulation was feasible and simulated all procedural steps with high fidelity. This model may be applicable for assessment of technical competencies and standard endovascular skill acquisition within vascular surgery training curricula.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chaer RA, Derubertis BG, Lin SC, Bush HL, Karwowski JK, Birk D, et al. Simulation improves resident performance in catheter-based intervention: results of a randomized, controlled study. Ann Surg. 2006;244(3):343–52.

    PubMed  PubMed Central  Google Scholar 

  2. Kim AH, Kendrick DE, Moorehead PA, Nagavalli A, Miller CP, Liu NT, et al. Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone. J Vasc Surg. 2016;64(1):251–8.

    Article  PubMed  Google Scholar 

  3. Vento V, Cercenelli L, Mascoli C, Gallitto E, Ancetti S, Faggioli G, et al. The role of simulation in boosting the learning curve in EVAR procedures. J Surg Educ. 2018;75(2):534–40.

    Article  PubMed  Google Scholar 

  4. Saratzis A, Calderbank T, Sidloff D, Bown MJ, Davies RS. Role of simulation in endovascular aneurysm repair (EVAR) training: a preliminary study. Eur J Vasc Endovasc Surg. 2017;53(2):193–8.

    Article  CAS  PubMed  Google Scholar 

  5. Dawson DL, Lee ES, Hedayati N, Pevec WC. Four-year experience with a regional program providing simulation-based endovascular training for vascular surgery fellows. J Surg Educ. 2009;66(6):330–5.

    Article  PubMed  Google Scholar 

  6. Taher F, Falkensammer J, McCarte J, Strassegger J, Uhlmann M, Schuch P, et al. The influence of prototype testing in three-dimensional aortic models on fenestrated endograft design. J Vasc Surg. 2017;65(6):1591–7.

    Article  PubMed  Google Scholar 

  7. Tam MD, Laycock SD, Brown JR, 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. 2013;20(6):863–7.

    Article  PubMed  Google Scholar 

  8. Tam MD, Latham TR, Lewis M, Khanna K, Zaman A, Parker M, et al. A pilot study assessing the impact of 3-D printed models of aortic aneurysms on management decisions in EVAR Planning. Vasc Endovasc Surg. 2016;50(1):4–9.

    Article  Google Scholar 

  9. Leotta DF, Starnes BW. Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms. J Vasc Surg. 2015;61(6):1637–41.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Huang J, Li G, Wang W, Wu K, Le T. 3D printing guiding stent graft fenestration: a novel technique for fenestration in endovascular aneurysm repair. Vascular. 2017;25(4):442–6.

    Article  PubMed  Google Scholar 

  11. Koleilat I, Jaeggli M, Ewing JA, Androes M, Simionescu DT, Eidt J. Interobserver variability in physician-modified endograft planning by comparison with a three-dimensional printed aortic model. J Vasc Surg. 2016;64(6):1789–96.

    Article  PubMed  Google Scholar 

  12. Meess KM, Izzo RL, Dryjski ML, Curl RE, Harris LM, Springer M, et al. 3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system. Proc SPIE Int Soc Opt Eng. 2017;10138:101380.

    Google Scholar 

  13. Torres IO, De Luccia N. A simulator for training in endovascular aneurysm repair: the use of three dimensional printers. Eur J Vasc Endovasc Surg. 2017;54(2):247–53.

    Article  CAS  PubMed  Google Scholar 

  14. Davis GR, Illig KA, Yang G, Nguyen TH, Shames ML. An approach to EVAR simulation using patient specific modeling. Ann Vasc Surg. 2014;28(7):1769–74.

    Article  PubMed  Google Scholar 

  15. Itagaki MW. Using 3D printed models for planning and guidance during endovascular intervention: a technical advance. Diagn Interv Radiol. 2015;21(4):338–41.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was first presented as a poster by Dr. Sandri at the Society for Vascular Surgery Vascular Annual Meeting in San Diego, USA, May 31, 2017. We acknowledge Mr. David G. Arch (Mayo Clinic Healthcare Technology Management) for his extensive pioneer work in building the current simulation setup.

Author information

Authors and Affiliations

  1. Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Jussi M. Kärkkäinen, Giuliano Sandri, Emanuel R. Tenorio, Karen Bjellum, Bernardo C. Mendes, Randall R. DeMartino & Gustavo S. Oderich

  2. Department of Radiology, Anatomic Modeling Laboratory, Mayo Clinic, Rochester, MN, USA

    Amy Alexander, Jane Matsumoto & Jonathan Morris

  3. Gonda Vascular Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Gustavo S. Oderich

Authors
  1. Jussi M. Kärkkäinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuliano Sandri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emanuel R. Tenorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amy Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen Bjellum
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jane Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jonathan Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bernardo C. Mendes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Randall R. DeMartino
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gustavo S. Oderich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gustavo S. Oderich.

Ethics declarations

Conflict of interest

Dr. Kärkkäinen has received personal research grants from following nonprofit organizations: Paulo Foundation (Finland), The Finnish Medical Foundation, Orion Research Foundation sr (Finland), Finnish Surgical Society and Finnish Society for Vascular Surgery. Dr. Oderich has received consulting fees and grants from Cook Medical, W. L. Gore and GE Healthcare (all paid to Mayo Clinic with no personal income). The other authors declare no conflict of interest.

Ethical Approval

This study did not involve any patient subjects; all simulations involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

This study has obtained IRB approval from Mayo Clinic and the need for informed consent was waived.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kärkkäinen, J.M., Sandri, G., Tenorio, E.R. et al. Simulation of Endovascular Aortic Repair Using 3D Printed Abdominal Aortic Aneurysm Model and Fluid Pump. Cardiovasc Intervent Radiol 42, 1627–1634 (2019). https://doi.org/10.1007/s00270-019-02257-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02257-y

Keywords

Search

Navigation