Background: Accurate prognoses are challenging in high-risk vascular conditions, such as abdominal aortic aneurysms, and limited diagnostic standards, decision-making criteria, and data semantics often hinder clinical reliability and impede diagnostics’ digital transition. This study aims to evaluate the performance, robustness, and usability of an automatic, replicable pipeline for aortic lumen surface reconstruction for pathological vessels. The goal is to provide a solid tool for geometric reconstruction to a more complex enhanced diagnostic framework. Methods: A U-Net convolutional neural network is trained using preoperative CTA scans, with 101 for model training and 14 for model testing, covering a wide anatomical and aortoiliac pathology spectrum. Validation included segmentation metric, robustness, reliability, and usability assessments. Performances are investigated by means of the test set’s prediction metrics for several instances of the model’s input. Clinical reliability is evaluated based on manual measurements performed by a vascular surgeon on the obtained 3D aortic lumen surfaces. Results: The test set is selected to cover a wide portion of aortoiliac pathologies. The algorithm demonstrated robustness with an average F1-score of 0.850 ± 0.120 and an intersection over union score of 0.760 ± 0.150 in the test set. Clinical reliability is assessed using the mean absolute errors for diameter and length measurements, respectively, of 1.73 mm and 2.27 mm. The 3D surface reconstruction demonstrated reliability, low processing times, and clinically valid reconstructions. Conclusions: The proposed algorithm can correctly reconstruct pathological vessels. Secondary aortoiliac pathologies are detected properly for challenging anatomies. To conclude, the proposed 3D reconstruction application to a digital, patient-specific diagnostic tool is, therefore, possible. Automatic replicable pipelines ensured the usability of the model’s outputs.

Background/Objectives: The aberrant subclavian artery (ASA) represents the most common congenital anomaly of the aortic arch, and is frequently associated with a Kommerell diverticulum, an aneurysmal dilation at the anomalous vessel origin. This condition carries a significant risk of rupture and dissection, and growing evidence indicates that local hemodynamic alterations may contribute to its development and progression. Computational Fluid Dynamics (CFD) provides a valuable non-invasive modality to assess biomechanical stresses and elucidate the pathophysiological mechanisms underlying these vascular abnormalities. Methods: In this study, twelve thoracic CT angiography scans were analyzed: six from patients with ASA and six from individuals with normal aortic anatomy. CFD simulations were performed using OpenFOAM, with standardized boundary conditions applied across all cases to isolate the influence of anatomical differences in flow behavior. Four key hemodynamic metrics were evaluated—Wall Shear Stress (WSS), Oscillatory Shear Index (OSI), Drag Forces (DF), and Turbulent Viscosity Ratio (TVR). The aortic arch was subdivided into Ishimaru zones 0–3, with an adapted definition accounting for ASA anatomy. For each region, time- and space-averaged quantities were computed to characterize mean values and oscillatory behavior. Conclusions: The findings demonstrate that patients with ASA exhibit markedly altered hemodynamics in zones 1–3 compared to controls, with consistently elevated WSS, OSI, DF, and TVR. The most pronounced abnormalities occurred in zones 2–3 near the origin of the aberrant vessel, where disturbed flow patterns and off-axis mechanical forces were observed. These features may promote chronic wall stress, endothelial dysfunction, and localized aneurysmal degeneration. Notably, two patients (M1 and M6) displayed particularly elevated drag forces and TVR in the distal arch, correlating with the presence of a distal aneurysm and right-sided arch configuration, respectively. Overall, this work supports the hypothesis that aberrant hemodynamics contribute to Kommerell diverticulum formation and progression, and highlights the CFD’s feasibility for clarifying disease mechanisms, characterizing flow patterns, and informing endovascular planning by identifying hemodynamically favorable landing zones.