Technological Advances to Address the Challenging Abdominal Aortic Aneurysm Neck

There have been significant technologic advances in endovascular aortic therapies since the introduction of conventional infrarenal aneurysm repair (EVAR). These sought to address weaknesses EVAR- particularly difficult or “hostile” neck. We review anatomical features that create a hostile neck and most recent advancements overcome these limitations. EndoAnchors replicate open suture fixation seal endograft tissue shown be useful as prophylactic measure short, angulated necks well therapeutic for type Ia endoleaks. Fenestrated EVAR (FEVAR) devices such Z-fen (Cook Medical, Bloomington, IN, USA) raises zone suprarenal segment while maintaining renal perfusion. Finally, multibranch grafts Thoracoabdominal Branch Endoprosthesis (Tambe; W. L. Gore & Associates, Flagstaff, AZ, raise above visceral can used off shelf with promising results.