The New Frontier of Planning in Complex

The New Frontier of Planning in
Complex Endovascular Aortic
Repair: the 3D Printing
Enrico Maria Marone, MD
Associated Professor of Vascular Surgery
University of Pavia - Italy
• I, Enrico Maria Marone DO NOT have a
financial interest/arrangement or affiliation
with one or more organizations that could
be perceived as a real or apparent conflict
of interest in the context of the subject of
this presentation.
3D Printing
Additive manufacturing: principles
• Create objects adding material layer by layer
Virtual model
Slicing
3D printing
Different deploying and curing systems
Vascular Surgery
Image analysis
1 – CT Images
Image analysis
1 – CT Images
2 – Image
Segmentation
ROI setting
Image analysis
1 – CT Images
2 – Image
Segmentation
HU window
Image analysis
1 – CT Images
2 – Image
Segmentation
SEEDs setting
Image analysis
1 – CT Images
2 – Image
Segmentation
Region growing
Image analysis
1 – CT Images
2 – Image
Segmentation
Repeat with other structures
Image analysis
1 – CT Images
2 – Image
Segmentation
3 – 3D Rendering
Image analysis
4 – Mesh generation (.stl file)
Rendering di superficie
3D Rendering
Mesh: description of the surface
through oriented triangles.
.stl is the format accepted by 3D
printers.
Image analysis
5 – STL post-processing
Surface Smoothing  without compromising anatomical information
3D Printing
6 – Additional Post-Processing
Create interlocking parts
Visualize inner details
3D Printing
7 – Virtual Slicing
3D printer software cuts the virtual model in slices of the
same thickness the printer is able to lay down at each step
28 μm
3D Printing
Objet 30Pro 3D Printer
• Technology: Material Jetting
• Layer thickness: up to 16 μm
• In plane resolution: 100μm/10cm
Materials
• Photo-polymeric resins
• 7 materials + support material
• Opaque materials  VeroWhite
3D Printing
8 – 3D Printing
Phase 1: the printing head lays
down a layer of material
Phase 3: the printing tray
moves down
Phase 2: the printing head moves
back and cures the material with
UV light
3D Printing
9 – Post-Processing
Final model after parts coloring and
assembling
Case Study - Spleen
Splenic artery aneurysm esclusion
Aneurysm
Accessory
Spleen
Prof. Andrea Pietrabissa
Direttore Chirurgia Generale 2
IRCCS Policlinico San Matteo, Pavia
Prof. Ferdinando Auricchio
Dip. Ingegneria Civile e Architettura
Università degli Studi di Pavia
Prof. Andrea Pietrabissa
Direttore Chirurgia Generale 2
IRCCS Policlinico San Matteo, Pavia
Prof. Ferdinando Auricchio
Dip. Ingegneria Civile e Architettura
Università degli Studi di Pavia
case 1
Case Study - Aorta
FL rupture
due to FL reperfusion
Home-made candy-plug
Vascular plug
Cook Converter
(24 mm)
Limb extension
(24 mm)
FL occlusion
Vascular plug
Home-made candy-plug
FL shrinkage
FL occlusion
Case Study - Aorta
Case Study - Aorta
Case Study - Aorta
Case Study - Aorta
Case Study - Aorta
Case Study - Aorta
Future developments
• 3D prototyping of patient-specific models that
resemble also mechanical properties of the
specific tissue
• Quantitative assessment of the
error between virtual model,
3D printed model and
operative specimen
Conclusions
• 3D printing adds specific informations in
complex endovascular aortic repair
• Problems related to costs of production and
time to actualize the model (60 hours to
create a 3D aorta)
• Need of a legal-medical validation