PhD Scientific Days 2026

Poster Session 1.P - Cardiovascular Medicine and Research

Digital Evaluation of Strut Compatibility Across Multiple Stent-Grafts for Complex Aortic Aneurysms

Name of the presenter

Juhos, Bendegúz

Institute/workplace of the presenter

Semmelweis Doctoral College

Authors

Bendegúz Juhos MSc¹, András Szentiványi MD, PhD¹, Csaba Csobay-Novák MD, PhD¹
1: Semmelweis Aortic Center, Department of Interventional Radiology, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary

Text of the abstract

Introduction
Physician-modified endografts (PMEGs) rely on precise alignment between patient-specific fenestration layouts and the underlying stent-graft strut architecture. Despite standardized approaches, predicting the precise quantitative interaction between patient-specific fenestration layouts and various strut architectures remains a complex challenge.

Aims
To compare the geometric compatibility of patient specific, four-fenestration PMEG templates across three platforms (Valiant, Treo, and Endurant) using unified positional tolerances and a standardized alignment algorithm to quantify global feasibility and the need for local adjustments.

Methods
28 consecutive PMEG planning cases were retrospectively analyzed by 3 operators using our custom-built EndoDraft® software. Fenestration templates were overlaid onto calibrated 32 mm manufacturer endograft strut schematics. Global alignment was assessed using unrestricted circumferential rotation and platform-specific axial translation limits. Strut conflict was defined as >1 mm overlap, and effective cannulable opening reduction (shuttering) was limited to ≤50%.

Results
Across 84 overlays per platform, global feasibility without local edits differed significantly (p < 0.0001): Treo 94.0%, Valiant 84.5%, and Endurant 11.9%. Consequently, local fenestration adjustments were required in 6.0%, 15.5%, and 88.1% of cases, respectively. Sub-millimeter strut overlap (<1 mm) occurred in 50.0% (Treo), 77.4% (Valiant), and 98.8% (Endurant) of overlays. The Endurant platform frequently reached shuttering limits (21.4%) and necessitated vessel omission due to main-body length restrictions (21.4%).

Conclusion
Valiant and Treo demonstrated high geometric compatibility with PMEG templates, achieving global feasibility with minimal local adjustments. In contrast, Endurant was substantially constrained by its proximal strut pattern, requiring frequent local edits and exhibiting multiple platform-specific limitations.

Funding
Supported by the 2024-2.1.2-EKÖP-KDP-2024-00002 University Research Scholarship Programme of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.