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Abstract Background: Endovascular treatment of aortic aneurysm (EVAR) has established itself as the first-line of treatment in abdominal aortic aneurysm (AAA) patients with suitable anatomy; on the contrary, in patients with unfavorable anatomy endovascular treatment is still a subject of great debate. The anatomical limitations are related mostly to the characteristics of the proximal neck, otherwise known as hostile neck anatomy (HNA) which can make a proper sealing difficult. Objective: We aim to evaluate the effectiveness of endovascular treatment of AAA with HNA, with commenting on the perioperative complications, mortality and morbidity. Methods: We retrospectively reviewed the pre-operative, intra-operative, and post-operative data of ten patients with infra-renal AAA with HNA identified from records of the vascular department at Cairo University Hospitals. Results: Pre-operative CTA assessment showed eight patients (80%) with neck length < 15mm, three patients (30%) with neck diameter > 28mm, two patients (20%) with neck angulation > 60{u00B0}. The maximum AAA diameter ranged from 50 mm to 152 mm. Nine patients (90%) achieved technical success while one patient (10%) achieved assisted technical success. In the 30 days follow-up period, no cases of mortality were documented, one case (10%) had graft limb occlusion and one case (10%) developed type Ia endoleak. In the one year follow-up period; one case died due to rupture of AAA |