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Page 12 of 14 Squizzato et al. Vessel Plus 2023;7:16 https://dx.doi.org/10.20517/2574-1209.2023.05

Gaps in knowledge
Despite significant advancements in endovascular techniques, there are still gaps in our knowledge
regarding the optimal management of the sealing zone. One major knowledge gap lies in the understanding
of the impact of the endograft rigidity on the aortic arch. How the endograft impacts anatomical variations,
such as tortuosity and angulation of the aorta, on the long-term adequacy of the sealing zone remains an
area of ongoing research. Further investigations are required to determine the optimal device selection and
deployment strategies in challenging anatomical cases. Closing these knowledge gaps will contribute to
improving patient outcomes and refining the techniques used in TEVAR procedures.

CONCLUSION
Length of proximal sealing represents the most important factor associated with early and long-term results
after TEVAR. A shorter proximal sealing length is associated with an increased risk of endograft migration
or type Ia endoleak, especially if < 2 cm. A longer sealing protects from proximal endograft failure, but may
require a more aggressive SAT debranching or the use of a more complex endovascular approach, with
associated technical challenges and increased perioperative risk. During the preoperative planning of the
proximal sealing length, specific anatomical, hemodynamic, pathological, and clinical factors should be
evaluated in order to optimize the clinical outcomes, tailoring an optimal sealing length to each patient.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Squizzato F, Spertino A, Grego F, Antonello M, Piazza M
Performed data acquisition, as well as provided administrative, technical, and material support: Squizzato F,
Spertino A, Grego F, Antonello M, Piazza M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023.

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