Hostile Proximal Neck: Angulated, Short, or Conical

Hostile neck anatomy (HNA) denotes anatomically unfavourable anatomy along the segment of aorta between the lowest renal artery and commencement of the aneurysm. It is the most frequent determinant of ineligibility for endovascular repair (EVAR). HNA is associated with increased technical difficulty and a greater risk type 1a endoleak (loss of the proximal seal), reintervention, secondary rupture, renal injury, and death. This chapter delineates relevant anatomical features utilised to determine HNA, the essentials of pre-operative assessment, and available treatment options: off-the-shelf devices, use of adjuncts, fenestrated and chimney EVARs.