The Hostile Neck

In This Section:

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Clinical publications

Guidelines

Review Articles

Techniques

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The treatment of complex thoracic and aortic aneurysms with hostile necks represents a major challenge compared to that with friendly neck anatomy. To date, the available therapeutic options including open and endovascular techniques have no true algorithm for the use in hostile anatomies, and surgeons worldwide lack clinical strategies and insights on how to expand current treatment options to more challenging cases.

This dedicated homepage aims to collate the current literature on this topic, and also seeks to bring the vascular community closer together to ensure optimal patient care and improved outcomes in this patient population. I hope that this time-saving resource will help like-minded physicians to learn more and interact on this topic. I also invite you to share and present your experience and cases in this section or through our dedicated journal, Vascular and Endovascular Review which is indexed in Scopus and the Directory of Open Access Journals (DOAJ).

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Recent Videos

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ANCHOR Study: ESAR is More than Reinforced Proximal Seal

Michel Reijnen,

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MEET THE EXPERT in Branched Endovascular Aortic Repair

Eric L G Verhoeven, Timothy Resch, Tara Mastracci, et al

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MEET THE EXPERT in Fenestrated Endovascular Aortic Repair

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Clinical publications

Transposition of anomalous left vertebral to carotid artery during the management of thoracic aortic dissections and aneurysms

Potter HA, Ziegler KR, Weaver FA, et al. J Vasc Surg 2022; epub ahead of press.

One-year sac regression is associated with freedom from fatal adverse events after endovascular aneurysm repair

Ikeda S, Sato T, Kawai Y, et al. J Vasc Surg 2022; epub ahead of press.

The association between device instructions for use adherence and outcomes after elective endovascular aortic abdominal aneurysm repair

De Guerre LEVM, O’Donnell TFX, Varkevisser RRB, et al. J Vasc Surg 2022;76:690–8.e2.

A stable aneurysm sac after endovascular aneurysm repair as a predictor for mortality: an in-depth analysis

Boer GJ, Schröder LBW, Disli MC, et al. J Vasc Surg 2022;76:445–53.

Long-term outcomes of endovascular aneurysm repair according to instructions for use adherence status

Hahl T, Protto S, Järvenpää V, et al. J Vasc Surg 2022;76:699–706.e2.

Partial and complete explantation of aortic endografts in the modern era

Feldman ZM, Kim D, Roddy C, et al. J Vasc Surg 2022; epub ahead of press.

Mid-term outcomes of late open conversion with endograft preservation for sac enlargement after endovascular abdominal aortic aneurysm repair

Ohmori T, Hiraoka A, Chikazawa G, Yoshitaka H. Ann Vasc Surg 2022; epub ahead of press.

One-year outcome of postoperative stroke and nerve injury after supraclavicular revascularization of the left subclavian artery for proximal landing zone extension in thoracic endovascular aortic repair

Brusa J, Lutz E, Schoenhoff FS, et al. Ann Vasc Surg 2022;83:265–74.

"Aortic Balloon Molding" during ovation endograft implantation expands graft use for hostile neck anatomy

Jensen R, Mathlouthi A, Al-Nouri O, et al. Ann Vasc Surg 2022;86:58–67.

Identification of key genes and pathways involved in abdominal aortic aneurysm initiation and progression

Su Z, Gu Y. Vascular 2022;30:639–49.

Can we still teach open repair of abdominal aortic aneurysm in the endovascular era? Single-center analysis on the evolution of procedural characteristics over 15 years

Trenner M, Radu O, Zschäpitz D, et al. J Surg Educ 2022;79:885–95.

Endurant stent graft in patients with challenging neck anatomy “one step outside instructions for use”: early and midterm results from the EAGLE registry

van Basten Batenburg M, 't Mannetje YW, van Sambeek MRHM, et al. Eur J Vasc Endovasc Surg 2022; epub ahead of press.

Thirty-day results from the ZEPHYR registry: outcomes of EVAR using the Zenith Alpha™ Abdominal Endovascular Graft for the treatment of AAA in 347 patients

Hatzl J, Batenburg MVB, Yeung KK, et al. Ann Vasc Surg 2022;78:170–9.

Late type 1A endoleaks: associated factors, prognosis and management strategies

O'Donnell TF, McElroy IE, Mohebali J, et al. Ann Vasc Surg 2022;80:273–82.

Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

Reyes Valdivia A, Milner R, Heijmen R, et al. Vascular 2022; epub ahead of press.

Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis—The PERU registry

Reyes Valdivia A, Chaudhuri A, Milner R, et al. Vascular 2022;30:27–37.

Chimney endovascular aneurysm repair (ChEVAR) for hostile neck complex aneurysm

Bath J, Fazzini S, Ippoliti A, et al. Vascular 2022; epub ahead of press.

Distal landing zone outcomes in thoracic endovascular aortic aneurysm repair with challenging morphology: a propensity-matched comparison of distal active fixation versus standard stent-graft

Gennai S, Leone N, Karelis A, et al. Int Angiol 2022;41:24–32.

Remodeling of abdominal aortic aneurysm sac following endovascular aortic repair: association with clinical, surgical, and genetic factors

D'Oria M, Di Girolamo FG, Calvagna C, et al. Cardiovasc Pathol 2022;58:107405.

A five-year computed tomography follow-up study of proximal aortic neck dilatation after endovascular aortic repair using four contemporary types of endograft

Deltomme M, Van den Berge S, Mufty H, et al. Cardiovasc Intervent Radiol 2022;45:272–3.

Long-term outcomes of the Endurant and Excluder stent grafts for endovascular aneurysm repair in a Japanese cohort

Sekimoto Y, Fujimura N, Matsubara K, et al. J Endovasc Ther 2022; epub ahead of press.

Two decades of abdominal aortic endovascular repair with the Anatomical FiXation at the aortic bifurcation in a large single-center experience

Gennai S, Andreoli F, Saitta G, et al. J Endovasc Ther 2022;29:42–56.

Early clinical outcomes of the active seal technology of the AFX endovascular aortic aneurysm system with the VELA cuff for patients with a conical proximal neck

Fujimura N, Obara H, Nagano T, et al. J Endovasc Ther 2022; epub ahead of press.

Early clinical outcomes of initial launch of the Zenith Alpha Abdominal Endovascular graft in Japan

Fujimura N, Ichihashi S, Obara H, et al. J Endovasc Ther 2022; epub ahead of press.

Fenestrated aortic aneurysm repair in patients treated inside versus outside of instructions for use

Stern JR, Deslarzes-Dubuis C, Tran K, Lee JT. J Endovasc Ther 2022; epub ahead of press.

Endovascular treatment of abdominal aortic aneurysm with severe angulation of infrarenal aortic neck by Gore conformable endograft

Mascoli C, Faggioli G, Goretti M, et al. J Endovasc Ther 2022; epub ahead of press.

Long-term results of angulated versus hyperangulated neck in endovascular aneurysm repair with endurant endoprosthesis

Özdemir-van Brunschot DMD, Torsello GB, Bernardini G, et al. J Endovasc Ther 2022; epub ahead of press.

Supra- and infra-renal aortic neck diameter increase after endovascular repair of a ruptured abdominal aortic aneurysm

van der Riet C, Schuurmann RCL, Karelis A, et al. J Clin Med 2022;11:1203.

Nationwide analysis of persistent type II endoleak and late outcomes of endovascular abdominal aortic aneurysm repair in Japan: a propensity-matched analysis

Seike Y, Matsuda H, Shimizu H, et al. Circulation 2022;145:1056–66.

Intraluminal thrombus and abdominal aortic aneurysm complications

Manenti A, Farinetti A, Manco G, Mattioli AV. Ann Vasc Surg 2022;83:E11–2.

Anatomical feasibility of the current endovascular solutions for Juxtarenal aortic abdominal aneurysm repair

Gallitto E, Faggioli G, Logiacco A, et al. Vascular 2022; epub ahead of press.

Endograft apposition and infrarenal neck enlargement after endovascular aortic aneurysm repair

van der Riet C, DE Rooy PM, Tielliu IF, et al. J Cardiovasc Surg (Torino) 2021;62:600–8.

Outcomes of elective use of the chimney endovascular technique in pararenal aortic pathologic processes

Pitoulias GA, Torsello G, Austermann M, et al. J Vasc Surg 2021;73:433–42.

Long-term chimney/snorkel endovascular aortic aneurysm repair experience for complex abdominal aortic pathologies within the PERICLES registry

Taneva GT, Lee JT, Tran K, et al. J Vasc Surg 2021;73:1942–9.

Impact of proximal neck anatomy on short-term and mid-term outcomes after treatment of abdominal aortic aneurysms with new-generation low-profile endografts

D'Oria M, Galeazzi E, Veraldi GF, et al. Ann Vasc Surg 2021; epub ahead of press.

Favorable outcomes in octogenarians with hostile neck undergoing endovascular repair using EndoAnchors

Locham S, Mathlouthi A, Dakour-Aridi H, Malas MB. Ann Vasc Surg 2021;74:194–203.

The role of surgical and total endovascular techniques in the treatment of ruptured juxtarenal aortic aneurysms

Keschenau PR, Beropoulis E, Gombert A, et al. Vasa 2021;50:356–62.

A multicenter "real-world" study of the valiant NAVION stent graft

Reyes-Valdivia A, Kratimenos T, Ferraresi M, et al. Int J Cardiol 2021;331:63–8.

Endovascular aortic repair in patients with challenging anatomies: the EXTREME study

Sirignano P, Mansour W, Capoccia L, et al. EuroIntervention 2021;16:e1544–50.

Determination of optimal and safest proximal sealing length during thoracic endovascular aortic repair

Piazza M, Squizzato F, Xodo A, et al. Eur J Vasc Endovasc Surg 2021;62:423–30.

The PROTAGORAS 2.0 study to identify sizing and planning predictors for optimal outcomes in abdominal chimney endovascular procedures

Fazzini S, Martinelli O, Torsello G, et al. Eur J Vasc Endovasc Surg 2021;61:591–602.

Editor's choice – mid term outcomes of crossed limb vs. standard limb configuration in endovascular abdominal aortic aneurysm repair: a propensity score analysis

Wang J, Zhao J, Ma Y, et al. Eur J Vasc Endovasc Surg 2021;61:579–88.

Risk factors, dynamics, and clinical consequences of aortic neck dilatation after standard endovascular aneurysm repair

Oliveira NFG, Oliveira-Pinto J, van Rijn MJ, et al. Eur J Vasc Endovasc Surg 2021;62:26–35.

A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms—the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol

Patel SR, Ormesher DC, Smith SR, et al. BMJ Open 2021;11:e054493.

Prospective multicentre cohort study of fenestrated and branched endografts after failed endovascular infrarenal aortic aneurysm repair with type Ia endoleak

Hostalrich A, Mesnard T, Soler R, et al. Eur J Vasc Endovasc Surg 2021;62:540–8.

Guidelines

European expert opinion on infrarenal sealing zone definition and management in endovascular aortic repair patients: a Delphi consensus

de Vries JPM, Zuidema R, Bicknell CD, et al. J Endovasc Ther 2022; epub ahead of press.

Radiation awareness for endovascular abdominal aortic aneurysm repair in the hybrid operating room: an instant operator risk chart for daily practice

de Ruiter QMB, Moll FL, Hazenberg CEVB, van Herwaarden JA. J Endovasc Ther 2021;28:530–41.

Review Articles

Endografts for the treatment of abdominal aortic aneurysms with a hostile neck anatomy: a systematic review

Pitros C, Mansi P, Kakkos S. Front Surg 2022;9:872705.

A systematic review and meta-analysis of proximal aortic neck dilatation after endovascular abdominal aortic aneurysm repair

Chatzelas DA, Loutradis CN, Pitoulias AG, et al. J Vasc Surg 2022; epub ahead of press.

Extrathoracic aneurysms in Marfan syndrome: a systematic review of the literature

Requejo-García L, Martínez-López R, Plana-Andani E, et al. Ann Vasc Surg 2022; epub ahead of press.

Renal outcomes of suprarenal vs. infrarenal endograft fixation in endovascular abdominal aortic aneurysm repair: a narrative review

Geragotellis A, Cox K, Yip HCA, et al. Cardiovasc Diagn Ther 2022;12:531–44.

Pre-operative aortic neck characteristics and post-operative sealing zone as predictors of type 1a endoleak and migration after endovascular aneurysm repair: a systematic review and meta-analysis

Zuidema R, van der Riet C, El Moumni M, et al. Eur J Vasc Endovasc Surg 2022; epub ahead of press.

Is EVAR feasible in challenging aortic neck anatomies? A technical review and ethical discussion

Sirignano P, Ceruti S, Aloisi F, et al. J Clin Med 2022;11:4460.

The Incraft stent graft for the treatment of abdominal aortic aneurysms: an iliac-friendly device with an effective conventional proximal sealing mechanism

Schoretsanitis N, Georgakarakos E, Argyriou C, et al. Expert Rev Med Devices 2022;19:37–41.

Update on the TREO endograft device: overview of its safety and efficacy

Georgakarakos E, Karaolanis GI, Argyriou C, et al. Expert Rev Med Devices 2022;19:31–5.

A meta-analysis of safety and efficacy of endovascular aneurysm repair in aneurysm patients with severe angulated infrarenal neck

Bernardini G, Litterscheid S, Torsello GB, et al. PLoS One 2022;17:e0264327.

Editor's choice – comparison of open, standard, and complex endovascular aortic repair treatments for juxtarenal/short neck aneurysms: a systematic review and network meta-analysis

Patel SR, Ormesher DC, Griffin R, et al. Eur J Vasc Endovasc Surg 2022;63:696–706.

Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR)

Karaolanis GI, Antonopoulos CN, Scali S, et al. Vascular 2021; epub ahead of press.

Experience with unfavorable iliac access when performing fenestrated/branched endovascular aneurysm repair

Hertault A, Bianchini A, Daniel G, et al. J Endovasc Ther 2021;28:315–22.

The polymer-based technology in the endovascular treatment of abdominal aortic aneurysms

de Donato G, Pasqui E, Panzano C, et al. Polymers (Basel) 2021;13:1196.

Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms

Elhelali A, Hynes N, Devane D, et al. Cochrane Database Syst Rev 2021;6:CD012923.

Prognostic role of severe infrarenal aortic neck angulation in endovascular aneurysm repair

Qayyum H, Hansrani V, Antoniou GA. Eur J Vasc Endovasc Surg 2021;62:409–21.

Techniques

Preliminary assessment of intra-aneurysm sac pressure during endovascular aneurysm repair as an early prognostic factor of aneurysm enlargement

Antkiewicz M, Protasiewicz M, Kuliczkowski W, et al. Vasc Health Risk Manag 2022;18:677–84.

Thoracic endograft placement using a transfemoral snare in a patient with angled aortic arch

Çamci S, Ari S, Ari H, Göncü MT. Vascular 2022;30:616–9.

Prediction of abdominal aortic aneurysm growth by artificial intelligence taking into account clinical, biologic, morphologic, and biomechanical variables

Kontopodis N, Klontzas M, Tzirakis K, et al. Vascular 2022; epub ahead of press.

Identification of geometric and mechanical factors predictive of bird-beak configuration in thoracic endovascular aortic repair using computational models of stent graft deployment

Shahbazian N, Romero DA, Forbes TL, Amon CH. JVS Vasc Sci 2022;3:259–73.

Postendovascular aneurysmal repair increase in local energy loss for fusiform abdominal aortic aneurysm: assessments with 4D flow MRI

Horiguchi R, Takehara Y, Sugiyama M, et al. J Magn Reson Imaging 2022; epub ahead of press.

Aortic arch type, a novel morphological indicator and the risk for acute type B aortic dissection

Sun L, Li J, Liu Z, et al. Interact Cardiovasc Thorac Surg 2022;34:446–52.

Impact of cone beam computed tomography in advanced endovascular aortic aneurysm repair using last generation 3D C-arm

Mezzetto L, Mastrorilli D, Abatucci G, et al. Ann Vasc Surg 2022;78:132–40.

Real-time evaluation of blood flow patterns using AneurysmFlow for an in vivo abdominal aortic aneurysm model

Park YJ, Mok SK, Park SC, et al. Ann Vasc Surg 2022;80:256–63.

New morphological factor for predicting late proximal type I endoleak after endovascular aneurysm repair

Banno H, Sugimoto M, Sato T, et al. Ann Vasc Surg 2022;81:154–62.

Development and comparison of multimodal models for preoperative prediction of outcomes after endovascular aneurysm repair

Wang Y, Zhou M, Ding Y, et al. Front Cardiovasc Med 2022;9:870132.

Estimation model for hypothermic circulatory arrest time to predict risk in total arch replacement

Sato H, Kawaharada N, Fukada J, et al. Ann Thorac Surg 2022;113:256–63.

Endovascular repair for acute type B aortic dissection with unfavorable proximal landing zone

Chang H, Wang Y, Liu B, et al. Ann Thorac Surg 2022;113:545–53.

A deep learning-based and fully automated pipeline for thoracic aorta geometric analysis and planning for endovascular repair from computed tomography

Saitta S, Sturla F, Caimi A, et al. J Digit Imaging 2022;35:226–39.

A statistical shape model of the morphological variation of the infrarenal abdominal aortic aneurysm neck

van Veldhuizen WA, Schuurmann RCL, IJpma FFA, et al. J Clin Med 2022;11:1687.

The predictive value of elliptical neck parameters and oversizing ratio for type Ia endoleaks after endovascular aneurysm repair

Qing M, Wang J, Zhao J, et al. J Vasc Interv Radiol 2022;33:375–83.e5.

Exclusion of complex aortic aneurysm with chimney endovascular aortic repair is applicable in a minority of patients treated with fenestrated endografts

Kliewer M, Pelanek-Völk E, Plimon M, et al. Interact Cardiovasc Thorac Surg 2021;32:460–6.

Computational analysis of endovascular aortic repair proximal seal zone preservation with endoanchors: a case study in cylindrical neck anatomy

Abbott E, Dhara S, Khabaz K, et al. JVS Vasc Sci 2021;2:170–8.

Sheath-anchoring for rail guidewire technique to advance and deploy thoracic endograft in hostile anatomy

Mastrorilli D, Mezzetto L, Scorsone L, et al. Ann Vasc Surg 2021; epub ahead of press.

Initial clinical experience with a new conformable abdominal aortic endograft: aortic neck coverage and curvature analysis in challenging aortic necks

Finotello A, Schuurmann R, Di Gregorio S, et al. J Endovasc Ther 2021;28:407–14.

Use of chimney technique does not improve the outcome of endovascular aneurysm repair in patients with a hyperangulated and short proximal aortic neck

Özdemir-van Brunschot DMD, Torsello GB, Bernardini G, et al. J Endovasc Ther 2021; epub ahead of press.

Implications of abnormal ascending aorta geometry for risk prediction of acute type A aortic dissection

Della Corte A, Rubino AS, Montella AP, et al. Eur J Cardiothorac Surg 2021;60:978–86.

A novel personalized dosimetry method for endovascular aneurysm repair (EVAR) procedures

Tzanis E, Perisinakis K, Ioannou CV, et al. Eur Radiol 2021;31:6547–54.

Aortic septotomy to optimize landing zones during thoracic endovascular aortic repair for chronic type B aortic dissection

Fukuhara S, Khaja MS, Williams DM, et al. J Thorac Cardiovasc Surg 2021; epub ahead of press.