CASE REPORT article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
This article is part of the Research TopicExploring New Frontiers in Heart Surgery: Case Studies 2025View all 24 articles
3D Printing-Assisted Triple-Vessel In Situ Fenestration Combined with a Diameter-Restricting Technique for a Complex Giant Aortic Arch Aneurysm in an Octogenarian: A Case Report and Technical Innovation
Provisionally accepted
- 1Suining Central Hospital, Suining, China
- 2Department of Cardiovascular Surgery, Suining Central Hospital, Suining, China
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Background: Aortic arch aneurysms involving branch vessels traditionally require open surgery with cardiopulmonary bypass, which poses prohibitive risks for octogenarians with complex comorbidities. This case demonstrates the successful application of total endovascular aortic repair (TEVAR) with three dimensional (3D) printing-assisted triple-vessel in situ fenestration and a diameter-restricting technique in an 85-year-old patient with a giant (9.0 cm) aortic arch aneurysm involving the left subclavian artery. Case presentation: The involvement of the three arch branches (brachiocephalic trunk, left common carotid artery, and left subclavian artery) necessitated precise revascularization. In comparison with traditional in situ fenestration, 3D printing-guided ex vivo fenestration enabled pre-release stent modeling on a 1:1 aortic arch replica (error <1 mm), allowing anatomically tailored fenestration positioning and eliminating blind puncture-related complications. A proximal stent diameter-restricting technique addressed the challenging anchoring zone gradient (33.6→27.3 mm), improving stent apposition and reducing type I endoleak risk. Intraoperative multiaccess reconstruction (femoral/axillary/cervical approach) achieved complete aneurysm exclusion. Postoperative computed tomography angiography on day 4 confirmed patent branches and absence of endoleaks, while 6-month follow-up demonstrated stable stent position and no neurological complications. Conclusion: This case highlights that TEVAR with 3D printing-assisted ex vivo fenestration and a diameter-restricting technique can serve as a viable alternative to open surgery for high-risk octogenarians with complex aortic arch aneurysms, overcoming traditional limitations of in situ fenestration while preserving cerebral perfusion. Further studies are warranted to validate this approach in larger populations.
Keywords: 3D printing, Aortic arch aneurysm, Octogenarian, Triple-Vessel In Situ Fenestration, case report
Received: 13 Aug 2025; Accepted: 20 Nov 2025.
Copyright: © 2025 Yin, Chen, Ge, Tang, Liu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yong-Heng Zhang, mfqq_258383@sohu.com
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