The Influence of Stent-Strut Morphology on Iliac Limb Hemodynamics During EVAR in Compliant 3D-Printed Arterial Models

Background: Endovascular aortic aneurysm repair (EVAR) is considered the gold standard for the treatment of abdominal aortic aneurysms. However, the performance of stent-grafts used during this procedure may be affected by their structural design, particularly in anatomically challenging, tortuous iliac arteries. This study aimed to evaluate the hemodynamic performance of different stent-graft limb designs in an in vitro EVAR simulation using compliant three-dimensional (3D)-printed iliac artery models with controlled angulations. Methods: Four commercially available stent-grafts (Anaconda®, Endurant II®, Treo®, Zenith Spiral-Z®) representing different stent-strut configurations (including O-ring, Z-stent, and spiral designs) were deployed in compliant 3D-printed vascular phantoms simulating severe iliac angulations of 75°, 90°, and 105°. The models were incorporated into a pulsatile flow circuit, and pressure and flow velocity were measured proximally and distally to the angulated segment. Results: Across all tested angulations, the O-ring-based design demonstrated the most favorable hemodynamic performance. In particular, the Anaconda stent-graft showed the smallest pressure loss and the lowest increase in distal flow velocity, especially in the 90° and 105° models. These findings suggest that O-ring-supported structures provide greater flexibility and conformability in severely angulated iliac segments. Conclusions: In this controlled in vitro setting, stent-grafts with O-ring strut morphology better preserved flow conditions than other tested configurations in tortuous anatomy. These results suggest that stent-graft structural design may influence device behavior in challenging iliac anatomy under controlled in vitro conditions. These findings should be considered hypothesis-generating bench data and do not represent direct evidence for clinical device selection.