Automated Laser Modified EndoGraft (ALMEG)

Abstract

Objectives: To describe the technical details of a new and innovative method for modifying endografts to treat complex aortic aneurysms, especially in limited time and under stressful conditions. The first case ever performed using this method is also described.Method description:Automated Laser Modified EndoGraft (ALMEG) is a new method developed in Thoracic and cardiovascular Center, Linköping University Hospital, Sweden. A simple planning program was designed, and an automated laser fenestration machine was built to assist in planning and modification of endograft in cases with complex aortic aneurysm anatomy requiring repair. The planning program generates a patient's template based on computerized tomography angiography. The endograft is un-sheathed in a sterile environment and then scanned to generate an endograft template. The 2 templates are used to identify the optimal positions of fenestrations on the endograft. The laser machine then cuts fenestrations automatically and shortens the endograft if needed. The fenestrations are reinforced with nitinol wire and diameter-reducing ties are added to the endograft. The endograft is then re-sheathed and deployed in patient's aorta.

Conclusion: ALMEG is a standardized and automated version of Physician Modified EndoGraft (PMEG) to minimize human error and to speed up the endograft modification procedure. The high precision and high speed of laser galvanometer together with the simplicity of our planning program refine and escalate the potential of PMEG. In stressful conditions and when the time factor is crucial as in ruptured complex aortic aneurysm, ALMEG offers a promising solution.Clinical ImpactThe introduction of Automated Laser Modified EndoGraft (ALMEG) marks a significant advancement in the management of complex aortic aneurysms. This innovative method is faster and less prone to human error compared to the traditional Physician Modified EndoGraft (PMEG). The simplicity and accuracy of ALMEG, along with its high speed, optimize the PMEG process, potentially setting a new standard in the field. Further integration with artificial intelligence may streamline endograft modification even more, broadening its applicability in acute clinical scenarios.

Keywords: abdominal aortic aneurysm; aortic rupture; endograft; endovascular aneurysm repair; fenestration; physician modified endograft; thoracic aortic aneurysm; thoracoabdominal aortic aneurysm.