3D-printed model of simulation for acute thrombus removal in peripheral arteries

BACKGROUND: Surgical training and evaluation of medical devices require simulation models. The aim of this study was to assess a 3D -printed model as a training model for peripheral endovascular procedures, including thromboaspiration in acute limb ischemia (ALI).METHODS: The 3D-simulation model was modeled from an aorta and lower limbs CT scan by segmentation of the arterial light. The 3D simu-lator was printed in multimaterial with photo-polymerizable resins (Polyjet). The simulator consisted of interchangeable cartridges intended to reproduce the lower limb vasculature. The simulator was connected to a pump to obtain a pulsative flow. A gelled product was positioned in a cartridge just above a stenosis in order to simulate an ALI by in-situ thrombosis. Vascular interventionalists should perform a thrombo-aspiration (Indigo & REG;, Penumbra Inc., Alameda, CA, USA) by crossover in an experimental hybrid room (Discovery & REG;, General Electric, Boston, MA, USA). The analysis of the results was based on the feedback of vascular interventionalists using a Likert Psychometric Scale.RESULTS: A total of 6 vascular surgeons performed two training sessions in real-life conditions. Access to the target lesion was achieved by cross-over or antegrade approach with an 8 F -45 cm introducer. An angiogram was used to localize the thrombus. Due to the flow, a part of the thrombus was migrating from femoropopliteal segment to below the knee level. Thromboaspiration was realized by Indigo (Penumbra Inc.) CAT-8 and-6 with separators. The average score out of 5 was 4.5 (& PLUSMN;0.55) regarding anatomical reproducibility, 4.3 (& PLUSMN;0.82) for navigation, and 4.5 (& PLUSMN;0.84) for aspiration. The didactical evaluation showed a score of 4.3 (& PLUSMN;0.52) for improving technical skills. The improvement of the con-fidence score in the simulator was +1.2 (& PLUSMN;1.72).CONCLUSIONS: The 3D-simulation model for peripheral endovascular procedures provides a realistic training for thromboaspiration. This model could mimic different types of peripheral arterial pathologies and participate to the vascular interventionalists training.