The Hostile Neck

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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Prof Konstantinos Donas

Section Advisor

Prof Konstantinos Donas

Head of the Department of Vascular Surgery, Director of the Research Vascular Centre, Asklepios Clinic Langen, University of Frankfurt, Germany

The Radcliffe Hostile Neck educational hub is an independent program led by Prof K Donas.

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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.

Endurant stent graft demonstrates promising outcomes in challenging abdominal aortic aneurysm anatomy

Mwipatayi BP et al. J Vasc Surg. 2021 Jan;73(1):69-80.

Mid-Term Results of Endovascular Aneurysm Sealing in the Treatment of Abdominal Aortic Aneurysm With Unfavorable Morphology

Dzieciuchowicz Ł et al. Vasc Endovascular Surg. 2021 Jan;55(1):39-49.

Early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between severe and non-severe infrarenal neck angulation

Chinsakchai K et al. Vascular. 2020 Dec;28(6):683-691.

Early periaortic hematoma development after EVAR in the presence of severely calcified and modestly conical-shaped aortic neck: A potential trigger for sudden aneurysm progression toward rupture

De Santis F et al. Vascular. 2020 Dec 13:1708538120978030.

The Treovance aortic stent graft can confer advantage in dealing with the patient origin-related unfavorable abdominal aortic aneurysm anatomy

Georgakarakos E et al. J Vasc Surg. 2020 Dec;72(6):2213.

Factors affecting the occurrence of proximal endoleak after endovascular abdominal aortic repair for abdominal aneurysms

Mazzaccaro D et al. J Int Med Res. 2020 Nov;48(11):300060520971515.

Use of the Ovation Endograft System to Treat Abdominal Aortic Aneurysms With Hostile Anatomy

Morgan-Bates K et al. Eur J Vasc Endovasc Surg. 2020 Nov;60(5):786-787.

Morphologic Features of Symptomatic and Ruptured Abdominal Aortic Aneurysm in Asian Patients

Wang H et al. Ann Vasc Surg. 2020 Nov 4:S0890-5096(20)30932-8.

Long-term outcomes of the Ovation Stent Graft System investigational device exemption trial for endovascular abdominal aortic aneurysm repair

Barleben A et al. J Vasc Surg. 2020 Nov;72(5):1667-1673.e1.

Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

de Niet A et al. J Endovasc Ther. 2020 Oct;27(5):848-856.

The Effects of Gender on Radiation Dose during Fenestrated Endovascular Aneurysm Repair

Klein A et al. Ann Vasc Surg. 2020 Oct;68:305-309.

Mid-term outcomes of endovascular aneurysm repair in challenging aortic neck anatomy based on experience from the GREAT C3 registry

Sayed T et al. J Cardiovasc Surg (Torino). 2020 Oct;61(5):610-616.

Predictors of Aneurysm Sac Shrinkage Utilizing a Global Registry

Boutrous ML et al. Ann Vasc Surg. 2020 Sep 2:S0890-5096(20)30791-3.

LUCY results show females have equivalent outcomes to males following endovascular abdominal aortic aneurysm repair despite more complex aortic morphology

Ash J et al. J Vasc Surg. 2020 Aug;72(2):566-575.e4.

The Italian Multicentre Registry of Fenestrated Anaconda™ Endografts for Complex Abdominal Aortic Aneurysms Repair

Pini R et al. Eur J Vasc Endovasc Surg. 2020 Aug;60(2):181-191.

Sex-Related Outcomes After Endovascular Aneurysm Repair Within the Global Registry for Endovascular Aortic Treatment

Mwipatayi BP et al. Ann Vasc Surg. 2020 Aug;67:242-253.e4.

Five Year Results of the French EPI-ANA-01 Registry of Anaconda(TM) Endografts in the Treatment of Infrarenal Abdominal Aortic Aneurysms

Midy D et al. Eur J Vasc Endovasc Surg. 2020 Jul;60(1):16-25.

Outcomes after treatment of complex aortic abdominal aneurysms with the fenestrated Anaconda endograft

de Niet A et al. J Vasc Surg. 2020 Jul;72(1):25-35.e1.

One-Year Results From the SURPASS Observational Registry of the CTAG Stent-Graft With the Active Control System

Torsello GF et al. J Endovasc Ther. 2020 Jun;27(3):421-427.

Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms and safety of Suprarenal Aortic Clamping

Jeong S et al. World J Surg. 2020 Jun;44(6):2002-2009.

A comparison of clinical outcomes of abdominal aortic aneurysm patients with favorable and hostile neck angulation treated by endovascular repair with the Treovance stent graft

Murray D et al. J Vasc Surg. 2020 Jun;71(6):1881-1889.

Comparison of midterm results of endovascular aneurysm repair for ruptured and elective abdominal aortic aneurysms

Oliveira-Pinto J et al. J Vasc Surg. 2020 May;71(5):1554-1563.e1.

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.

Endoluminal Management of Infra-renal Aortic and Aorto-iliac Aneurysms

Holden A et al. Cardiovasc Intervent Radiol. 2020 Dec;43(12):1788-1797.

An update on the ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives

Georgakarakos E et al. Expert Rev Med Devices. 2020 Dec;17(12):1249-1256.

An update on the improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms

Kontopodis N et al. Expert Rev Med Devices. 2020 Nov;17(11):1231-1238.

Endovascular Aortic Repair with the "Step-by-Step" Deployment of the Endurant Stent-Graft System in Severe Neck Angulation: Technique and Review of the Literature

Tasselli S et al. Ann Vasc Surg. 2020 Oct;68:553-558.

Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants

Karaolanis G et al. Vascular. 2020 Oct;28(5):568-576.

Radial Access For Neurointerventions

Roger Barranco Pons, 2020

Similar 5-year outcomes between female and male patients undergoing elective endovascular abdominal aortic aneurysm repair with the Ovation stent graft

Varkevisser RRB et al. J Vasc Surg. 2020 Jul;72(1):114-121.

Improved Midterm Outcomes Using Standard Devices and EndoAnchors for Endovascular Repair of Abdominal Aortic Aneurysms with Hyperangulated Necks

Chaudhuri A et al. Cardiovasc Intervent Radiol. 2020 Jul;43(7):971-980.

Systematic review and meta-analysis of outcomes of open and endovascular repair of ruptured abdominal aortic aneurysm in patients with hostile vs. friendly aortic anatomy

Kontopodis N, Tavlas E, Ioannou CV, et al. Eur J Vasc Endovasc Surg 2020;59:717–28.

Next-Generation Conformable EVAR Device With 90o Angulated Aortic Neck

Sarah Eaton, 2018

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.

Predictors of inadequate EndoAnchors aortic wall penetration for the Endosutured therapy in hostile neck patients

Reyes Valdivia A et al. J Cardiovasc Surg (Torino). 2020 Dec;61(6):738-744.

Full-Volume Assessment of Abdominal Aortic Aneurysms by 3-D Ultrasound and Magnetic Tracking

Zielinski AH et al. Ultrasound Med Biol. 2020 Dec;46(12):3440-3447.

Physician-modified fenestrated endovascular repair of type 1A endoleaks from polymer-based low-profile endografts

Zhang L et al. Vascular. 2020 Nov 13:1708538120972242.

Comparison of Abdominal Aortic Aneurysm Sac and Neck Wall Motion with 4D Ultrasound Imaging

Derwich W et al. Eur J Vasc Endovasc Surg. 2020 Oct;60(4):539-547.

Endovascular aortic repair with the Gore Excluder Conformable endograft in severe neck angulation: Preliminary experience and technical aspects

Bonvini S et al. Vascular. 2020 Sep 1:1708538120952665.

Total Luminal Volume Predicts Risk after Endovascular Aneurysm Repair

Oliveira-Pinto J et al. Eur J Vasc Endovasc Surg. 2020 Jun;59(6):918-927.

Parallel Covered Stents Technique in the Treatment of Abdominal Aortic Diseases

Yao C et al. J Vasc Interv Radiol. 2020 May;31(5):771-777.

Cutting the Gordian Knot of Abdominal Aneurysm Hostile Neck Definitions with the Ovation Stent Graft

Georgakarakos E et al. Ann Vasc Surg. 2020 May;65:e294-e295.

Parallel Grafts to Treat Juxtarenal Aneurysms Using the Ovation Stent Graft System

Kontopodis N et al. Eur J Vasc Endovasc Surg. 2020 Sep;60(3):479.