Simulation of Endovascular Aortic Repair Using 3D Printed Abdominal Aortic Aneurysm Model and Fluid Pump
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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.
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.
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.
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.
KeywordsEndovascular aortic repair EVAR Simulation 3D printing Abdominal aortic aneurysm
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.
Compliance with the Ethical Standards
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.
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.
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.
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