THREE-DIMENSIONAL PRINTING IN VASCULAR AND ENDOVASCULAR SURGERY: ARTIFICIAL VASCULAR MODELS IN THE TREATMENT OF AORTIC DISEASE

Novotný R.¹, Rydlo J.², Raška P.², Chlupáč J.^1,4, Janoušek L.^1,3, Froněk J.^1,4

¹Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague

²Department of Information, Institute for Clinical and Experimental Medicine, Prague

³First Faculty of Medicine, Charles University, Prague

⁴Department of Anatomy, Second Faculty of Medicine, Charles University, Prague

Introduction: Three-dimensional (3D) printing is a process which generates prototypes from virtual objects in a computer-aided design software. It is a rapidly expanding field in the age of personalized medicine. We are presenting the use of 3D printing in surgical planning before the treatment of aortic diseases in vascular surgery. The use of 3D printing for the treatment of aortic disease has been used at our centre since March 2019.

Method: We are using ITK-SNAP opensource software to create 3D organ models, which enables medical data segmentation from CT or MR, followed by visualization and 3D rendering of the model. This program supports work with DICOM data, saves segmentation in NIfTI format, and exports the resulting model as an STL file. Segmentation can be performed manually or semi-automatically. The semi-automatic segmentation we use is divided into four steps: ROI selection, Presegmentation – create a mask, Initialization – insertion of spherical volumes, Evolution – segmentation within object boundaries. Manual segmentation is the tracing or colouring of an object and is used to correct inaccuracies created during semi-automatic segmentation. The last step is to set the rendering parameters of the resulting model and export it to STL format. We are using the Ultimaker S5 printer with glass support. The material used for aortic models is the Ultimaker PLA RED, a water-soluble Ultimaker PVA support material. The consumption of PLA RED averages 110 g and dissolvable PVA 151 g per model. Printing time 45 hours. The thickness of the printed layer is 0.15 mm. Dissolution of support stands is done in a container of hot water (20 hours).

Conclusion: 3D printing in vascular surgery is still not widely used and is considered an unnecessary luxury. However, advances in the accessibility of 3D printing have the potential to revolutionize the treatment of aortic diseases.