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Page 10 of 14 Squizzato et al. Vessel Plus 2023;7:16 https://dx.doi.org/10.20517/2574-1209.2023.05

Figure 7. CTA with multiplanar reconstruction of an intramural hematoma, complicated by a focal type B dissection, with hematoma
extension in the aortic arch.

Figure 8. CTA with multiplanar reconstruction of a penetrating aortic ulcer (zone 5) with associated intramural hematoma. Dashed red
line highlights its proximal and distal extension; recommended landing zone should be at the level of the green dashed line.

between the endograft and the dilated aortic wall, leading to an increased risk of gradual loss of sealing over
time .
[33]
In type I aortic arches we usually plan 20 mm sealing length proximally, 25 mm sealing length in type II and
III arches whenever possible. Regardless of the sealing zone and arch type, a minimum 25 mm sealing
length is also recommended in cases of evident angulation, thrombus or calcifications .
[33]

Chronic dissection
Chronic dissections are characterized by a progressive dilatation primarily of the proximal descending
thoracic aorta (zones 2 and 3) . Thus, TEVAR may not always be anatomically feasible due to the overall
[38]
enlargement of the aortic arch, making zones 1, 2 and 3 unsuitable for a standard thoracic endograft.
Moreover, a prior ascending aorta substitution may be present in those cases with residual dissection after
type A repair. In our experience, the use of aortic arch endografts is particularly helpful for the treatment of
chronic dissection, since they allow safe landing in zone 0, guaranteeing a minimally invasive treatment.