## 4 Discussion  
Our study shows that 3 DPPVMs demonstrate good accuracy and realism, as the participants scored them more than 3.8 out of 5 in most application areas. The models developed in this study scored highly, with a mean score of 4.2 to 4.3 for closely replicating anatomy, a mean score of \(>\)4.2 for clarifying pathology to patients, and a mean score of 4.0 for clarifying pathology to health professionals. With the inclusion of four different vascular models comprising common vascular pathologies, this study's findings contribute valuable information to the literature, reinforcing the usefulness of 3 DPPVMs in the field of cardiovascular disease. \begin{table}
\begin{tabular}{l l l} \hline \hline
**Themes** & **Resposes** & **Total** \\ \hline General comments on & Excellent potential tool (\(n=2\)) & (\(n=2\)) \\
3 DPPVM & & (\(n=2\)) \\ Visual advantages of & Visually more realistic than CTA images (\(n=1\)) & \\
3 DPPVM & Excellent for visualising complex pathology, & \\  & which cannot be achieved by imaging alone (\(n=1\)) & (\(n=2\)) \\ Use of 3 DPPVM as a training aid & Useful for education in complex cases (\(n=2\)) & (\(n=5\)) \\  & Helpful tool for patient education (\(n=3\)) & (\(n=5\)) \\ Use of 3 DPPVM for & Useful for surgical planning of complex cases (\(n=2\)) & (\(n=2\)) \\ surgical planning & & \\ Use of 3 DPPVM to & Excellent for complex pathology (\(n=1\)) & (\(n=1\)) \\  & demonstrate disease to & \\ health professionals & & \\ Limitations of 3 DPPVM & Include blood flow to remedy static model nature (\(n=2\)) & \\  & Introduce arterial pressure for realism (\(n=1\)) & \\  & Extend access vessels for aortic simulation (\(n=1\)) & (\(n=4\)) \\ Participant suggestions & Model the supporting scaffold to mimic surrounding & \\ for 3 DPPVM improvement & anatomy (\(n=1\)) & \\  & Have access site to lesion for true orientation (\(n=1\)) & \\  & Create a clear model to visualise simulation (\(n=1\)) & (\(n=3\)) \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Thematic summary of clinicians’ responses on qualitative assessment. Figure 6: Responses of participants on their recommendation of the use of 3 DPPVMs. Three-dimensional-printed vascular models are showing great promise in medical education and the pre-surgical planning and simulation of complex endovascular procedures [8; 9; 10; 11; 12; 13; 14; 15; 16; 19; 20]. Three-dimensional-printed models are not only highly accurate but also possess high haptic and fluoroscopic fidelity, which makes them suitable for training and simulation purposes. [PERSON] et al. performed a systematic review of nine studies focusing on the development of 3D-printed templates to guide fenustrated physician-modified stent grafts [19]. Although the review included studies with design limitations (five case reports, one technical report, and one letter to the editor, with only two prospective trials), it showed the potential value of using 3D-printed templates to assist with the placement of fenestrated stent grafts in patients with complex or challenging aortic aneurysms, as it could lead to a significant reduction in costs and increase the accuracy of fenestration alignment. This was also confirmed by a recent review on the application of 3D-printed models in the planning of complex aortic aneurysm repair [21]. By comparing a 3D printing-guided group with a non-3D printing-guided group, it was found that the cardiopulmonary bypass time (170 vs. 181 min) and total circulatory arrest time (12 vs. 13.5 min) were reduced; however, no significant differences were found between the two groups in other areas, such as the total operative time, hospitalisation duration, and intensive care unit admission duration [21; 22]. The authors also indicated the importance of incorporating artificial intelligence into image processing and segmentation, as AI-driven 3D printing will significantly reduce the time and effort required for printing such models [22; 23].