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Squizzato et al. Vessel Plus 2023;7:16 https://dx.doi.org/10.20517/2574-1209.2023.05 Page 7 of 14

Table 1. Literature review of selected articles reporting the impact of sealing zone length in TEVAR
Study Year N. of patients Aortic pathology Cases < 2 cm sealing length
Boufi et al. [29] 2015 84 AD,TAA,BTAI, PAU, IMH 40%
[30]
Kuo et al. 2019 71 AD 68%
[31]
Yoon and Mell 2020 63 AD, TAA, BTAI, PAU 71%
[32]
Lombardi et al. 2021 110 AD 83%
[33]
Piazza et al. 2021 140 AD, TAA, BTAI, PAU 11%
AD: Aortic dissection; TAA: thoracic aortic aneurysm; BTAI: blunt traumatic aortic injury; PAU: penetrating aortic ulcer; IMH: intramural
heamatoma.

Table 2. Proximal sealing zone optimal and safest length calculation for thoracic endovascular aortic repair stratified by aortic arch
type and sealing zone [32]
Proximal sealing Minimum recommended sealing length (mm) Safest sealing length (mm)
Type I arch
Overall 20 25
Zones 2 and 3 only 20 25
Type II arch
Overall 25 30
Zones 2 and 3 only 25 30
Type III arch
Overall 25 30
Zones 2 and 3 only 25 30

Figure 5. Penalized smooth splines function of the hazard ratios for proximal endograft failure vs. proximal sealing length after TEVAR.
The 95% confidence interval is represented by the dashed red line.

potential complexities associated with more intricate debranching procedures. Therefore, the planning of
each case should be tailored to the specific anatomical and clinical conditions of the patient.

It is important to acknowledge that there may be challenging anatomical situations, such as type III arches
with steep angulations, where achieving complete graft-to-aortic wall apposition in the proximal landing
zone is only partially attainable. In such cases, the debranching of supra-aortic vessels and the planning of
the proximal landing zone must be meticulously executed, taking into account the unique anatomical
characteristics of the patient. This approach aims to maximize the length of endograft apposition and its