FEVAR /BEVAR have limitations and do not always represent the preferred option for juxtarenal reconstruction
Following the definition given by the recent ESVS guidelines, juxtarenal abdominal aortic aneurysm (JAAA) is defined as an aneurysm extending
up to but not involving the renal arteries, necessitating suprarenal aortic clamping for open surgery, i.e. a short neck (<10 mm). JAAA repair
always represents a challenge intervention, either by open or endovascular means, mostly related to the renal arteries involvement. Concerning
endovascular repair, different options can be considered. Among them, fenestrated endografts (FEVAR) should be considered as a first option1,
due to their reported safety and efficacy. However, when the anatomy is not favorable or when FEVAR devices are not available in an emergency
setting for instance, other alternatives can be considered like parallel graft or chimney technique (ChEVAR). Do nothing is the last alternative
when medical and anatomical circumstances are absolutely poor. In the following pages, we will review the limitations of FEVAR and branched
endografts, the better indications and anatomical conditions for a successful repair with ChEVAR technique and its current clinical results reported
in the literature.