Proximal Seal After Endovascular Aneurysm Repair: Why Sealing Length Dynamics and Type 2 Endoleak Matter
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By
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Giulio Accarino
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Raffaele Pulli
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Felice Pecoraro
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Domenico Angiletta
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Nabile Belouafa
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Salvatore Bruno
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Stefano Attolini
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Francesca Noce
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Mostafa El Moumni
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Jean-Paul P. M. de Vries
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Umberto Marcello Bracale
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July 6, 2026
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Clinical Scorecard: Dynamics of Sealing Length and Type 2 Endoleak in Proximal Sealing Following Endovascular Aneurysm Repair
At a Glance
| Category | Detail |
|---|
| Condition | Infrarenal Abdominal Aortic Aneurysm (AAA) |
| Key Mechanisms | Proximal sealing changes and endoleak dynamics post-EVAR |
| Target Population | Patients undergoing elective or urgent EVAR for fusiform infrarenal AAA |
| Care Setting | Multicenter retrospective study |
Key Highlights
- EVAR is the predominant treatment for infrarenal AAA with lower peri-operative morbidity than open repair.
- Type 2 endoleak (EL2) is the most frequent endoleak after EVAR, with varying clinical significance.
- Proximal sealing length (SL) changes post-EVAR are associated with later EL1A occurrences.
- Structured follow-up is emphasized to detect endoleaks and seal-related complications.
- Loss of proximal sealing can increase rupture risk.
Guideline-Based Recommendations
Diagnosis
- Routine computed tomography angiography (CTA) within 1 month and at 1 year post-EVAR.
Management
- Surveillance protocols should include clinical assessment and imaging at least annually.
Monitoring & Follow-up
- Monitor for endoleaks, sac enlargement, migration, and seal-related complications.
Risks
- Loss of proximal sealing leading to type 1A endoleak increases rupture risk.
Patient & Prescribing Data
Consecutive patients with fusiform infrarenal AAA undergoing EVAR.
Inclusion criteria focused on degenerative pathology; exclusion of non-degenerative conditions.
Clinical Best Practices
- Follow a standardized protocol for assessing CTAs based on defined criteria.
- Evaluate sealing metrics longitudinally rather than relying on a single measurement.
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