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Enhancing Surgical Precision: Patient-Specific 3D Model for Vascular Calcification Assessment

Case Study

In vascular surgery, the precision of clamping for complex surgeries such as organ transplantation is pivotal to safeguard the vessel and ensure the procedure's ultimate success.Clamping in areas with pronounced calcification may lead to insufficient vessel occlusion post-clamping, compromising the procedure's efficacy.

The significant challenges posed by vascular calcification in major vessels necessitate meticulous pre-operative planning and innovative solutions to ensure the safety and success of surgical procedures and transplants. This article delves into the transformative impact of a patient-specific 3D anatomical model for use in renal transplant surgery, offering a detailed assessment of calcification levels within the abdominal aorta and inferior vena cava.

The Challenge: Vascular Calcification of Major Vessels

In pursuit of a safe clamping zone and assessment of a suitable site for reimplantation of vascular structures, surgical teams encounter a common challenge among their patients—profound vascular calcification. This calcification is prominently visible on the non-contrast CT scans, providing a comprehensive depiction of the vascular walls' calcification. The team shares these CT scan images to gain insights into the circumferential calcification; however, despite this clarity, identifying an optimal clamping location for safely securing the artery remains elusive. The focus is on obtaining a precise clamp placement, creating an opening in the artery, and subsequently facilitating the delicate maneuver of parachuting the renal artery into this opening.

In this case, faced with the task of safely clamping the renal artery, the surgical team confronted a unique challenge. Despite the seemingly straightforward nature of the case, circumferential calcification in the aorta and common iliac posed a potential obstacle. Analyzing the CT scan images, the team discovered a distinctive shoe-shaped, semi-circumferential calcification at the back of the artery. The surgeon recognized that clamping at this site could risk clamp closure failure or even fracture, potentially occluding blood supply to the leg.

Addressing this intricate challenge underscores the requirement for clinicians to possess accurate pre-operative planning tools that offer detailed insights into the extent and distribution of calcification.

The Solution: Patient-Specific 3D Anatomical Model

To overcome the complexities of vascular calcification, the team turned to Axial3D to transform the patient’s 2D imaging into both a 3D virtual and physical representation of the patient’s anatomy. This innovative solution aimed to replicate the in-situ feel of the affected vessels, offering a comprehensive representation of the calcified abdominal aorta and inferior vena cava. The model featured a suturable, compliant vessel wall and solid calcification, mimicking real human tissue, allowing surgeons to simulate surgical scenarios and assess calcification levels within the aorta.

Through harnessing the patient-specific model, surgeons discerned and designated areas with minimal calcification, assuring clamping in regions of optimal vessel integrity. The adept utilization of the 3D model for pinpointing calcification-free secure clamping zones empowered the surgical team to maximize the prospects of a successful intervention.

Overcoming Transplant Waiting Lists

In the face of a substantial backlog with more than 5,000 patients currently awaiting transplantation nationally, where nearly 30% of them grapple with end-stage calcification, the integration of 3D printed models emerges as a transformative solution. By establishing a comprehensive library of these patient-specific anatomical models within respective transplant centers, surgical teams can efficiently address the challenges associated with vascular calcification. The ability to access these pre-prepared models streamlines the pre-operative planning process significantly. Instead of navigating through CT scans and making educated guesses, surgeons can seamlessly retrieve a patient's vascular model from the repository, allowing for a precise assessment of optimal clamping locations. This proactive approach not only enhances surgical preparedness but also promises to expedite the transplantation process, offering a potential breakthrough in reducing the current backlog and providing timely interventions for patients in need.

Precision, Safety, and Success

The utilization of a patient-specific 3D anatomical model for assessing vascular calcification within the abdominal aorta and inferior vena cava is revolutionizing pre-operative planning and surgical procedures. By offering a realistic, suturable model that replicates the in-situ feel, surgeons can make more informed decisions about clamping zones, minimizing the risk of vessel injury and ensuring successful outcomes. This innovative approach demonstrates the importance of technology and collaboration in addressing complex medical challenges, ultimately improving patient care and safety.

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