3D Rendering and Hybrid Therapy of a Complex Aortic Malformation

Background: Simultaneous or staged hybrid procedures to treat aortic malformations require careful planning. 3D rendering of the aorta using a 3D printer may aid in the visualization of complex vascular pathologies.

Case Presentation: A 54-year old patient presented with an aortic arch ending distal to the carotid arteries and an aneurysmatic distal aortic segment, aberrant origins of both subclavian arteries and a multi-loculated S-shaped aneurysm of the right subclavian artery that reached a diameter of more than 7 cm. Both aneurysms were connected by a shunt. A 3D model was created to visualize the complex pathology and aid in the planning of a staged hybrid approach. In a first stage, the patient underwent on-pump implantation of a 20 mm curved Dacron prosthesis between the ascending and abdominal segments of the aorta on CPB through a median sternotomy and upper mini-laparotomy. The aberrant persisting aortic segment and the right subclavian artery were both closed by ligation, and a 7 mm Dacron prosthesis was interposed between the proximal section of the aortic prosthesis and the right subclavian artery. Several days later, a 7 mm Dacron prosthesis was grafted from the left carotid to the left subclavian artery. Following this, two covered stents were deployed through the left femoral artery into the aneurysm taking care to preserve the right vertebral artery. Apart from a vein thrombosis in the right arm, the patient took an uncomplicated course. Post-operative imaging scans showed complete exclusion of the aneurysm, regular perfusion of all aortic branches, and absence of endoleaks.

Conclusion: Simultaneous or staged hybrid procedures are an appealing alternative to conventional open repair of complex aortic pathologies and may reduce operative risk and mortality. The 3D model gave us a good impression of the aortic pathology and prepared us for the challenges we faced during the different stages of the procedure. 3D rendering can be repeated several times in the course of a staged approach to provide updated 3D models showing the progress made at any given point in time.