| The Surgical Technologist | JUNE 2022 260 while planning, which would reduce interobserver human error during the preoperative phase [124, 125]. This technology allows decreasing the learning curve of vascular surgeons in many centers, reducing fluoroscopy time, and improving decision making in the choice of stents [120]; in complex cases, it manages to discard indications based on experimental models, where the desired results are not achieved, improving decision making in each case ranging from the choice of devices to the angular challenges of the real simulation, but it is the force to which it is subjected that provides great realism in cases of challenging hemodynamic management (Figure 4) [126, 127]. It is important to note that CT measurements for scheduling endovascular procedures are based on the central flow line. However, even modern workstations can not accurately predict the duration of treatment in cases of severe aortoiliac tortuosity [127]. These patients tend to shorten due to the combination of native aortic remodeling, stent conformability, and stiffness of guidewires and delivery systems during endovascular aneurysm repair [128]. Arterial deformations caused by endovascular equipment depend on multiple factors, such as the morphology of the arteries, the state and degree of arterial calcification, and the type of device used [129]. At present, their prediction is mainly based on the surgeon’s experience [130]. Attempts to predict the clinical application of 3DP are currently speculative [121, 131]. The additional cost and time required to produce devices with current 3DP still limit (a) Segmental artery Renal artery Celiac axis SMA (b) Visualization guide Marking guide (c) (d) Figure 4: 3D modeling processes for 3D aortic model. (a) Individual modeling of the central line of graft using the patient’s computed tomography (CT) images. (b) 3D computerized models for the graft guides consisting of the visualization (left) and the marking (right). (c) 3D printed guides. (d) Intraoperative view of the 3D printed guides in the TAAA. SMA: superior mesenteric artery; CA: celiac artery; RA: renal artery; TAAA: thoracoabdominal aortic aneurysm [137]. Used with permission from Elsevier. 8 BioMed Research International
RkJQdWJsaXNoZXIy MTExMDc1