Three-dimensional Simulations for Planning Fenestrated/branched Endografts in Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysm: a Retrospective Cohort Study

Background: Endovascular aneurysm repair (EVAR) is used to treat patients with abdominal aortic aneurysm (AAA) who have suitable anatomy, while complex AAAs often require fenestrated and branched stent grafts, necessitating further refinement of the technique. Objective: To evaluate the safety and efficacy of fenestrated/branched EVAR (F/B-EVAR) assisted by three-dimensional (3D) printing for treating complex AAA. Design: Retrospective cohort study. Methods: This multicenter retrospective cohort study collected baseline data and clinical outcomes from patients treated with F/B-EVAR between January 2012 and June 2025. The population was divided into the 3D simulation group and the conventional measurement group. The 3D simulation group underwent a simulation to assess fenestration and branch positioning strategies. Study endpoints included procedural success rate, incidence of periprocedural complications and major adverse events, as well as procedural duration and radiation dose. Results: The mean age of patients was 70.2 ± 8.8 years, with 68.9% being male. Compared to the conventional measurement group, the 3D simulation group had a significantly higher procedural success rate (98.8% vs 91.6%, p < 0.001), shorter procedural duration ((115.2 ± 35.0) min vs (138.7 ± 43.7) min, p < 0.001), and lower radiation dose ((107.2 ± 43.9) mGy vs (144.5 ± 56.3) mGy, p < 0.001). Furthermore, although no significant differences were observed in the incidence of all-cause mortality and major cardiovascular adverse events during the 30-day follow-up between the two groups, the incidence of life-threatening major bleeding, major vascular complications, and acute kidney injury stage ⩾3 was significantly lower in the 3D simulation group. Conclusion: F/B-EVAR guided by 3D simulation may allow for accurate planning of fenestration and branch positioning, potentially improving procedural success rate and suggesting a potential to enhance the quality of outcomes.