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Updated: Apr 23, 2026
Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training
Published on: January 18, 2021
CT-reconstructed three-dimensional printed models of the right subclavian artery and aorta define age-related changes
Erik Velez1, Nathan Boyer, Gabriel Acevedo-Bolton
1University of Newcastle Department of Medicine, Division of Cardiology, John Hunter Hospital, Lookout Rd, New Lambton Heights, Newcastle, NSW 2905, Australia. andrewboyle500@gmail.com.
Insights
Aging increases right subclavian artery (RSCA) tortuosity, complicating transradial cardiac catheterization. Three-dimensional models demonstrate how RSCA anatomy impacts catheter engagement success.
Area of Science:
- Vascular anatomy
- Interventional cardiology
- Medical imaging
Background:
- Severe tortuosity of the right subclavian artery (RSCA) complicates transradial cardiac catheterization, leading to longer procedures and potential failure.
- Increasing age is linked to subclavian artery tortuosity, but specific anatomical changes are not well-defined.
Purpose of the Study:
- To quantify age-related anatomical changes in the RSCA.
- To assess the impact of RSCA tortuosity on catheter engagement during cardiac catheterization using 3D printed models.
Main Methods:
- Chest CT angiograms from younger (<45) and older (≥75) patients were analyzed for RSCA tortuosity.
- Measurements included vessel length and an index of tortuosity (straight distance/midline length).
- 3D printed models of normal and tortuous RSCA were used for benchtop catheter testing.
Main Results:
- Older patients exhibited significantly longer and more tortuous RSCAs with increased posterior unfolding compared to younger patients.
- Catheter engagement of coronary arteries was successful with all tested catheters in the normal RSCA model.
- Only two of seven catheters successfully engaged coronary arteries in the tortuous RSCA model.
Conclusions:
- Advancing age is associated with RSCA elongation, tortuosity, and posterior unfolding.
- 3D printing is a feasible method for simulating and evaluating catheter performance in anatomically varied subclavian arteries.
Background:
Severe tortuosity of the right subclavian artery (RSCA) encountered during transradial cardiac catheterization can lead to longer procedures, increased fluoroscopy time, inability to engage the coronary artery ostia, and potentially procedural failure. Increasing age is strongly correlated with subclavian tortuosity; however, the magnitude and direction of age-related changes in aortic and subclavian artery anatomy have not been defined.
Methods:
Chest computed tomography (CT) angiograms of 14 patients (6 age <45 years and 8 age ≥75 years) were evaluated for RSCA tortuosity. Measurements were taken along the midline of the vessel and compared to the straight distance traveled (index of tortuosity = straight distance/midline length). One normal and one tortuous subclavian were selected for three-dimensional printing and various catheters were benchtop tested on both models.
Results:
The older group had longer (11.95 cm vs 9.6 cm; P<.01) and more tortuous subclavian arteries (lower index of tortuosity, 0.65 vs 0.76; P<.01) with more posterior unfolding (distance to most posterior aspect, 3.74 ± 0.77 cm vs 1.76 ± 0.58 cm; P<.001). Engagement of the coronary arteries of the normal model was significantly easier, with successful engagement of one or both coronaries with every catheter (n=7). Only 2 of 7 catheters (Radial Brachial and Extra Backup 3.0) were able to engage the coronary arteries in the tortuous model.
Conclusion:
Age is associated with elongation, tortuosity, and posterior unfolding of the RSCA. Three-dimensional printing of normal and tortuous arteries is feasible and shows potential to test differences between catheters.
