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Squizzato et al. Vessel Plus 2023;7:16 Vessel Plus
DOI: 10.20517/2574-1209.2023.05

Review Open Access

Optimization of the proximal sealing in thoracic

endovascular aortic repair (TEVAR)

Francesco Squizzato , Andrea Spertino , Franco Grego, Michele Antonello, Michele Piazza
Vascular and Endovascular Surgery, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua,
Padua 35128, Italy.

Correspondence to: Prof. Francesco Squizzato, Vascular and Endovascular Surgery Division, Padua University - Department of
Cardiac, Thoracic, Vascular Sciences and Public Health, Via Giustiniani, Padua 35128, Italy. E-mail:
francesco_squizzato@icloud.com
How to cite this article: Squizzato F, Spertino A, Grego F, Antonello M, Piazza M. Optimization of the proximal sealing in thoracic
endovascular aortic repair (TEVAR). Vessel Plus 2023;7:16. https://dx.doi.org/10.20517/2574-1209.2023.05
Received: 2 Feb 2023 First Decision: 30 Jun 2023 Revised: 13 Jul 2023 Accepted: 25 Jul 2023 Published: 28 Jul 2023

Academic Editor: Christopher Lau Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Thoracic endovascular aortic repair (TEVAR) today represents the first option for the treatment of most
pathologies involving the descending thoracic aorta. Proximal endograft failure, which includes endograft migration
or type IA endoleak, represents the most frequent complication during the mid-term and long-term period.
Proximal sealing length is the single most important factor affecting the technical success and durability of TEVAR.
Other factors related to aortic arch anatomy, fluid dynamics, type of endograft, or type of pathology, may influence
the risk of proximal endograft failure, and should be considered during the endovascular planning of the proximal
sealing length. This review summarizes the evidence on the factors affecting the risk of proximal endograft failure,
and provides the rationale for the choice of the proximal sealing length during TEVAR, based on specific patients’
characteristics.
Keywords: Thoracic aortic aneurism, thoracic endovascular aortic repair, aortic dissection, endoleak, sealing zone,
aortic arch, thoracic aorta

INTRODUCTION
Thoracic endovascular aortic repair (TEVAR) today represents the first option for the treatment of most
pathologies involving the descending thoracic aorta. Compared to open thoracic aortic repair, TEVAR

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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