Purpose or Case Report: The renal artery ostial anatomy, balloon profile, and stent deployment are all challenges of complex procedural RAS planning in children. In such cases there is an increased risk of renal artery rupture secondary to angioplasty requiring placement of a covered stent. This study aims to establish the feasibility of simulating renovascular stent deployment in three 3D printed pediatric patient-specific RAS endovascular phantoms.
Methods & Materials: A removable patient tailored RAS module facilitated patient specific pre-procedure planning and a training for rare procedure. Silicone poured in 3D printed molds were created from the patient’s CTA to create patient-specific models. Vascular access points were added for upper and lower extremity simulation and a pump was installed to simulate circulatory flow.
The three patient-specific models included bilateral kidneys with i) left inferior branch high grade RAS (80%),(ii) bilateral RAS (63% and 45%) with steep ostial angle, and (iii) moderate left RAS (30%) and high grade right RAS (80%).
Simulation steps: catheter and balloon entry via upper extremity, selective renal angiography, stenosis identification and transgression, non-low-profile cutting balloon angioplasty and balloon expandable stent simulation.
Operators completed a 10 point questionnaire, rating their experience using a 5-point Likert scale (1-Strongly disagree to 5-Strongly agree).
Results: Three complex renal angioplasty simulations were performed; for treatment planning, with simulation stent placement. Post simulation, an upper extremity approach was deemed necessary for cutting balloon stenosis transgression due to the steep renal artery ostial angulation, and change in clinical procedure approach planning.
Stents included; 1 PK Papyrus™ stent graft, 1 Viabahn, 1 Graftmaster. PK Papyrus™ and Graftmaster stents are humanitarian devices and off label in children.
Three operators Likert scale had good agreement (k=0.46) that the 3D printed phantom is helpful in procedure planning, skill development and provides a realistic experience from catheterization to stenting. The simulation resulted in a planned live patient brachial access in all 3 patients. Stent deployment simulation provides pre procedure training for a rare indication in children.
Conclusions: This first described renovascular “plug and play” phantom provides customized patient renovascular angioplasty pre procedure planning together with stent deployment simulation, all complex elements of this procedure in children.