Endovascular treatment of thoracoabdominal aortic pathologies using 3D printer-assisted physician-modified stent-grafts

Background: Thoracoabdominal aortic aneurysms (TAAAs) and dissections are among the most challenging vascular diseases. Endovascular interventions have gained prominence in the treatment of these diseases in recent years. However, the frequent involvement of the visceral or supra-aortic artery ostia in the proximal or distal landing zone increases the complexity of the procedure. Therefore, several techniques have been developed to address this challenge. In this study, we present our experience with thoracic endovascular aortic repair using three-dimensional (3D) printer-assisted physician-modified stent-grafts (PMSGs) for thoracoabdominal aortic pathologies involving the left subclavian artery, celiac trunk, superior mesenteric artery, or renal arteries. Methods: Between January 2020 and January 2023, a total of 18 patients presenting with complex aortic pathologies were screened for eligibility. Four patients were excluded because of active systemic infection/mycotic etiology (n=2) or unsuitable iliofemoral access (n=2). Consequently, 14 patients (12 with TAAAs and 2 with aortic arch dissections) were treated using 3D printer-assisted PMSGs. All aortic arch dissections extended to the left subclavian artery. Results: Fourteen patients underwent surgery with 3D printing guidance. The technical success rate was 92.8%. There were no perioperative deaths. The mean age was 68.07±10.6 years. The mean procedure time was 4.27±1.23 hours, including a mean custom graft preparation time of 1.3±0.6 hours. The mean intensive care unit stay was 5.64±11.54 days, and the mean hospital stay was 13.07±10.6 days. All 14 patients were followed for 2-12 months, with a mean follow-up of 6 months. Mortality occurred in 1 patient (7.1%). Conclusion: The 3D printer-assisted PMSG technique offers significant technical advantages by improving procedural precision and simplifying the creation of fenestrations for complex aortic pathologies. Our findings suggest that this technique provides a high technical success rate and represents a safe and feasible alternative for preserving vital side branches, particularly in settings where patient-specific custom-made grafts are not readily available.