A conical neck in hostile anatomies represents the single strongest factor associated with proximal failure of standard EVAR. This finding should be considered and highlighted apart from the length of the infrarenal neck to prevent midterm failure of standard EVAR.
Use of f-EVAR, b-EVAR, and ch-EVAR allows effective treatment of postsurgical pararenal aneurysms based on a clear algorithm and patient selection, highlighting the complementary character of these less invasive approaches.
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