Mixed reality-assisted physician-modified endograft fenestration for urgent repair of a complex infrarenal abdominal aortic aneurysm: First-in-the-world case

Figures

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  Fig 1. (A) A three-dimensional (3D) volume-rendered reconstruction of an abdominal aortic aneurysm (AAA) with a hostile neck, showing the anatomical features of the case. (B) A 3D multiplanar reconstruction showing an 86° hostile beta angle.

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  Fig 2. A three-dimensional (3D) model rendered in Blender showing the aortic wall mesh in transparency, with solid marking of the ostia by golden rings to facilitate overlay onto the physical endograft and guide marking with a sterile pen.

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  Fig 3. Screen captures from the procedure video acquired with Meta Quest 3, demonstrating the correct overlay and alignment of the virtual model with the physical endograft via mixed reality, contrasted with the surgeon's marking on the endograft.

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  Fig 4. Physician modification of the endograft, showing the fenestration reinforcement process performed with electrocautery; the edges are reinforced with a 20-mm radiopaque loop using 4-0 expanded polytetrafluoroethylene suture.

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  Fig 5. Final aortogram showing patency of the treated visceral vessels (superior mesenteric artery [SMA], right renal artery [RRA], left renal artery [LRA]) and exclusion of the aneurysm sac without evidence of endoleak.

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  Fig 6. Three-dimensional (3D) volume-rendered reconstruction of the 30-day follow-up computed tomography angiography (CTA) showing complete exclusion of the aneurysm and patency of the treated visceral vessels.