Feasibility of an Endovascular Training and Research Environment with Exchangeable Patient Specific 3D Printed Vascular Anatomy: Feasibility of a Simulator with Exchangeable Patient-Specific 3D-Printed Vascular Anatomy for Endovascular Training and Research Purposes.

PURPOSE Endovascular interventions have become standard procedures for the therapy of abdominal aortic aneurysms. Therefore, endovascular surgeons need special skills which had to be learned and trained. Additionally, authentic simulators are needed for further development of new endovascular devices and procedures. The aim of this project was to develop an authentic and modular endovascular simulation environment with patient-specific vascular anatomy for training and research purposes. MATERIAL AND METHODS We first designed a prototype with exchangeable 3D-printed patient-specific vascular anatomy. Then, the feasibility of the prototype was validated by a simulation of an EVAR procedure in a clinical setting. RESULTS We developed an authentic endovascular simulator with an exchangeable patient-specific vascular anatomy and performed an EVAR procedure under realistic conditions. The evaluation of the accuracy of the vascular models showed little deviation when compared with the original CT data. CONCLUSION Endovascular simulators based on patient-specific 3D-printed vascular models can realistically mimic endovascular procedures and have the potential to be used for further development of new devices and grafts as well as for training purposes. Furthermore, in our opinion they can reduce the use of animals during developmental processes.

[1]  Cristina Suarez-Mejias,et al.  3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia , 2015, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[2]  Hitesh Lal,et al.  3D printing and its applications in orthopaedic trauma: A technological marvel. , 2018, Journal of clinical orthopaedics and trauma.

[3]  Sebastian Mafeld,et al.  Three-dimensional (3D) printed endovascular simulation models: a feasibility study. , 2017, Annals of translational medicine.

[4]  C. Bakoyiannis,et al.  Animal models in the research of abdominal aortic aneurysms development. , 2017, Physiological Research.

[5]  M. Newman,et al.  Three-Dimensional Printing in Plastic and Reconstructive Surgery: A Systematic Review , 2016, Annals of plastic surgery.

[6]  Y. Chan,et al.  Evidence for Endovascular Simulation Training: A Systematic Review. , 2016, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[7]  I. Grunwald,et al.  A Pilot Study Assessing the Impact of 3-D Printed Models of Aortic Aneurysms on Management Decisions in EVAR Planning , 2016, Vascular and endovascular surgery.

[8]  S. Mafeld,et al.  The role of simulation in the development of endovascular surgical skills , 2016, Perspectives on Medical Education.

[9]  Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone. , 2016, Journal of vascular surgery.

[10]  Hans-Henning Eckstein,et al.  Simulator training on pulsatile vascular models significantly improves surgical skills and the quality of carotid patch plasty. , 2013, Journal of vascular surgery.

[11]  Thenkurussi Kesavadas,et al.  3D printing for preoperative planning and surgical training: a review , 2018, Biomedical Microdevices.

[12]  P. Kolh,et al.  Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. , 2019, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[13]  A. Freyrie,et al.  The Role of Simulation in Boosting the Learning Curve in EVAR Procedures. , 2017, Journal of surgical education.

[14]  B. Garg,et al.  Current status of 3D printing in spine surgery. , 2018, Journal of clinical orthopaedics and trauma.

[15]  R. Crawford,et al.  Continuous Flow Perfused Cadaver Model for Endovascular Training, Research, and Development. , 2017, Annals of vascular surgery.

[16]  G. Štrkalj,et al.  Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery , 2016, Front. Neuroanat..

[17]  J. Golledge,et al.  Animal models of abdominal aortic aneurysm and their role in furthering management of human disease. , 2011, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[18]  I. Torres,et al.  A simulator for training in endovascular aneurysm repair: The use of three dimensional printers. , 2017, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[19]  Andreas Bayer,et al.  An Endovascular Simulator based on Exchangeable 3D-printed Real Vascular Pathologies as Alternative to the use of Animals , 2019 .

[20]  N. Papenberg,et al.  [An Experimental Set-Up for Navigated-Contrast-Agent and Radiation Sparing Endovascular Aortic Repair (Nav-CARS EVAR)]. , 2015, Zentralblatt fur Chirurgie.

[21]  A. Amis,et al.  Rapid prototyping techniques for anatomical modelling in medicine. , 1997, Annals of the Royal College of Surgeons of England.

[22]  A Saratzis,et al.  Role of Simulation in Endovascular Aneurysm Repair (EVAR) Training: A Preliminary Study. , 2017, European Journal of Vascular and Endovascular Surgery.

[23]  N. Padmanabhan,et al.  Detecting dark matter annihilation with CMB polarization: Signatures and experimental prospects , 2005, astro-ph/0503486.

[24]  Daniel E. Kendrick,et al.  Endovascular Simulation Leads to Efficiency and Competence in Thoracic Endovascular Aortic Repair Procedures. , 2015, Journal of surgical education.