Author + information
- Received September 26, 2018
- Accepted October 2, 2018
- Published online April 15, 2019.
- Daniela Branzan, MDa,∗∗ (, )
- Dirk Winkler, MD, PhDb,∗,
- Andrej Schmidt, MD, PhDc,
- Dierk Scheinert, MD, PhDc and
- Ronny Grunert, PhDb,d
- aDepartment of Vascular Surgery, University of Leipzig, Leipzig, Germany
- bDepartment of Neurosurgery, University of Leipzig, Leipzig, Germany
- cDepartment of Angiology, University of Leipzig, Leipzig, Germany
- dFraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
- ↵∗Address for correspondence:
Dr. Daniela Branzan, Department of Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
A 61-year-old male patient with esophageal carcinoma and percutaneous gastrostomy was admitted to our institution with back pain. Computed tomographic angiography revealed a 47-mm penetrating aortic ulcer on the posterior wall of the aorta at the origin of the superior mesenteric artery (Figure 1A). Urgent repair was proposed using a physician-modified stent graft (PMSG) with 4 fenestrations for the visceral arteries. To increase the accuracy of the localization of the openings in the stent graft, a clear rigid hollow 3-dimensional aortic model (3D-AM) that included 6-mm holes at the locations of visceral vessels was created using a three-dimensional printer and biocompatible material (Formlabs, Somerville, Massachusetts) (Figure 2A). A 30 × 150 mm Valiant Captivia thoracic stent graft (Medtronic, Minneapolis, Minnesota) was deployed into the 3D-AM and rotated so that the fenestration would be localized in a strut-free area (Figure 2B). Two 8-mm fenestrations were created for the celiac trunk and superior mesenteric artery, and two 6-mm fenestrations were created for the renal arteries. All fenestrations were reinforced with the radiopaque tip of a V-18 guidewire (Boston Scientific, Marlborough, Massachusetts) (Figure 2C). After resheathing, the PMSG was deployed into the patient’s aorta using alignment of the superior mesenteric artery and left renal artery. Covered stents were placed in the fenestrations and their corresponding target artery. Post-procedural computed tomographic angiography showed patent visceral branches and no endoleak (Figure 1B). The patient was discharged on the sixth post-operative day with no neurological deficit.
Although PMSGs are an alternative treatment of acute thoracoabdominal aortic pathology, their planning does not account for the interaction between the stent graft and the angulated aorta, which might modify the alignment between the fenestrations and the ostia of the visceral vessels (1). To overcome this disadvantage, a three-dimensional aortic model was proposed in an aortic phantom (2). We are the first to present the use of a sterilized three-dimensional aortic model to facilitate the planning of PMSG deployment for the urgent treatment of a symptomatic penetrating aortic ulcer.
↵∗ Drs. Branzan and Winkler contributed equally to the manuscript.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 26, 2018.
- Accepted October 2, 2018.
- 2019 American College of Cardiology Foundation