3-dimensional printing of models to create custom-made devices for coil embolization of an anastomotic leak after aortic arch replacement.
OBJECTIVE
The objective of this study was to show the use of 3-dimensional printing models to fabricate a custom-made occluder for device embolization of an anastomotic leak after replacement of the ascending aorta and the aortic arch in a human immunodeficiency virus (HIV)-infected patient.


METHODS
We present a 50-year-old HIV-infected patient who underwent ascending aorta and aortic arch replacement for a type A dissection, and who had an aortic arch pseudoaneurysm (sized 5 x 5 x 4 cm) with a slit-shaped entrance hole located anteriorly to the implanted supra-aortic vessels. The patient's 128-slice computed tomography data were visualized and reconstructed. Afterward we fabricated a life-like replica of the complex pathology of the ascending aorta and the aortic arch using a rapid prototyping machine. After careful examination of the model, we fabricated a custom-made occluder device for interventional closure of the leakage.


RESULTS
Using data derived from 128-slid computed tomography linked to proprietary software, we were able to create models of the ascending aorta, the aortic arch end, especially the pseudoaneurysm with its slit-shaped opening between the aortic lumen and the aneurysm. This was very helpful to build a perfectly fitting custom-made occluder device to plan and simulate the interventional closure. Moreover, the models were helpful for intra-interventional orientation.


CONCLUSIONS
The stereolithographic replicas were extremely useful for choosing the treatment option and for planning and simulating the occlusion of the pseudoaneurysm. Furthermore, the models were necessary for our engineers who were building the custom-made occluder device.
Sodian
Ralf
R
Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany. ralf.sodian@med.uni-muenchen.de
Schmauss
Daniel
D
Schmitz
Christoph
C
Bigdeli
Amir
A
Haeberle
Sandra
S
Schmoeckel
Michael
M
Markert
Matthias
M
Lueth
Tim
T
Freudenthal
Franz
F
Reichart
Bruno
B
Kozlik-Feldmann
Rainer
R
D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D003198:Computer Simulation; D017076:Computer-Aided Design; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005500:Follow-Up Studies; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D017755:Prosthesis Fitting; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed