# Development of a 3D transparent aortic model as a radiation-free training simulator for basic skills of endovascular aortic interventions

## TL;DR

A 3D printed aortic model was developed to train vascular surgeons in endovascular procedures without radiation, significantly reducing task completion times for trainees.

## Contribution

A radiation-free 3D printed aortic model was developed and tested for training in endovascular procedures.

## Key findings

- Trainees reduced task completion time from 914 ± 420 s to 149 ± 48 s after using the 3D model.
- Experienced surgeons showed no significant improvement in task completion time.
- The model may help reduce fluoroscopy exposure in real procedures by improving trainee efficiency.

## Abstract

Endovascular aortic repair (EVAR) are gradually replacing open surgical repair for aortic diseases, due to their minimally invasive nature. These procedures require a high level of expertise that is gained through extensive clinical experience, posing risks such as prolonged radiation exposure. Training on 3D-printed simulation models can offer safer environment for learning & improve procedural precision & outcome.

A single-center study to evaluate whether training on radiation-free three-dimensional (3D) printed aortic training models can reduce the time required from vascular surgeons to complete the basic endovascular navigation tasks, such as navigating the guide wire & probing the different branches. We involved 15 vascular doctors, 8 in-experienced (group1) & 7-experienced (group2). Participants received a 15-min lecture on aortic interventions and guide wire handling. Two self-made 3D printed training models were used. Models either are of the entire aorta (ascending to iliacs, see model1) or thoracoabdominal aorta (model2) were used. A covering box and a camera positioned above the aortic model that mirror the intervention on a monitor, simulating the indirect vision of the intraoperative fluoroscopy. Participants were required to probe and intubate four aortic branches (two renal arteries, coeliac trunk, & superior mesenteric artery) in three steps: initial assessment, 15-min training, & post-training assessment (next day). Task completion times were recorded & analyzed.

Group1 initially required 914 ± 420 s to intubate four ostia, which significantly decreased to 149 ± 48 s post-training (p = 0.001). Experts showed no significant time reductions following the training (p = 0.443). Initial times were significantly lower for Group2 (p = 0.002), but post-training times showed no significant difference between both groups (p = 0.134).

Using 3D-printed models in a simulation-training may help to familiarize & train participants with endovascular aortic procedures within limited material costs, leading to significant reductions in task completion time among trainees. Additionally, a significant reduction in simulated visualization time was observed, suggesting potential for reduced fluoroscopy exposure in real procedures.

The institutional ethics committee of the University Hospital of Mainz approved this study.