The project aims to develop and validate a Mixed-Reality (MxR)-assisted workflow for the manufacturing of physician-modified stent grafts (PMEG). PMEGs enable patient-specific fenestrated endovascular aortic repair using readily available off-the-shelf stent grafts and are particularly valuable when custom-made devices cannot be obtained within the required timeframe. However, current PMEG manufacturing remains highly dependent on manual measurements and operator experience, with limited standardization of fenestration positioning and stent-strut avoidance.

The proposed approach combines a dedicated physical template with a virtual patient-specific stent-graft model displayed through a head-mounted Mixed-Reality device. The template establishes a defined spatial relationship between the physical stent graft and an optical marker, allowing the virtual model to be accurately registered and overlaid onto the actual device. The operator can then rotate the stent graft within the template to identify a configuration in which the planned fenestrations avoid the metallic stent struts, before transferring their positions onto the graft and performing the modification.

This workflow is intended to combine the advantages of existing punch-card and 3D-printed-model techniques while avoiding their major limitations. Patient-specific anatomical information is represented digitally rather than through a custom physical model, eliminating the need for time-consuming patient-specific 3D printing and sterilization. At the same time, manipulation of the stent graft is minimized, potentially reducing contamination risk and making the manufacturing process faster, more reproducible, and less dependent on local expertise.