ACS Bulletin - July 2016

understanding of a patient’s unique vasculature in a
way that traditional imaging alone cannot provide, as
well as to develop a preoperative surgical plan. 5
“When you do an angiogram and you take a blood
vessel picture or snapshot, a CT angiogram, an MRI
angiogram, it looks like, ‘There’s the problem, there’s
where I need to go,’” said Dr. Siddiqui, chief medical
officer, The Jacobs Institute, Buffalo. “The fact of the
matter is, when you try to perform the procedure in
reality, the impediments are such that you can’t make
your way up there with the tools you have or there is
less space in the artery than you originally thought,
and you need to make adjustments on the fly.” For
example, the surgeon may need to abandon the first
approach and try something else, such as entering
through the neck rather than the groin to reach an
aneurysm.
“What this translates into is multiple procedures,
multiple variations, longer procedures, [and] more
possibilities for complications,” Dr. Siddiqui said.
Employing a patient-specific 3-D model preoperatively
may be able to alleviate some of those problems.
Dr. Siddiqui and his colleagues at The Gates Vas-
cular Institute and University at Buffalo, including
scientists, clinicians, and trainees, meet weekly to dis-
cuss what cases would be best served by the technology.
“[Then] we say, hold on, this looks like a complicated
case. Let’s 3-D print this entire vascular anatomy, put
it in the lab, attach it to a flow pump, and let’s do the
whole procedure, from groin to vertex, artificially on
the 3-D printed model and work out the kinks,” he
said. The advantage of practicing on a 3-D printout
is to shift any trial-and-error element for a procedure
from a patient to a replaceable model, with the goal of
achieving improved outcomes and safer patient care.
“With 3-D printing, we are now able to take some
of the most complicated cases—specifically those with
lots of nuances to their anatomy that really aren’t appre-
ciable on a computer screen—and generate a model
that you can turn around in your hand,” said Albert
S. Woo, MD, an Associate Member of the ACS and
chief, pediatric plastic surgery, and director, craniofa-
cial program, division of plastic surgery, Warren Alpert
Medical School of Brown University, Providence, RI.
Dr. Woo and Steven Couch, MD, FACS, oculofacial
plastic surgeon and assistant professor of ophthalmol-
ogy, Washington University, used 3-D modeling to
carefully reconstruct Myah Mc Williams’ orbital defor-
mity while protecting the young patient’s tear ducts. 4
(At the time of Myah’s procedure, Dr. Woo was asso-
ciate professor, Washington University, and chief of
pediatric plastic surgery, St. Louis Children’s Hospital.)
Dr. Couch noted that a 3-D printed model made
preoperative visualization a more tangible experi-
ence. “The standard is, you look at a 2-D screen and
look at multiple views on the area—so in my case, you
look at coronal, axial, sagittal images—and you try to
develop a 3-D model in your mind,” he said, and the
repositioning or canting of the bone were done men-
tally. Dr. Couch acknowledges that while surgeons
have been doing this conceptualization for a long time,
“3-D printing potentially improves our ability to accu-
rately visualize in the preoperative setting.”
A 3-D-printed model was especially useful in
Myah’s case, in which a multidisciplinary team
needed to work together. “A model allows us to say,
‘My goal is to change this portion, this portion, and
this portion. How will that affect your portion of the
surgery? Is there a better way to expose this area?’”
Dr. Couch explained.
Dr. Siddiqui (in
background, right)
showing a medical device
executive how to coil an
aneurysm on a 3-D-printed
brain artery model, at the
State University of New
York (SUNY) at Buffalo’s