• Patient (m/f) age ≥ 18 years at time of enrollment.

• Diagnosis of thoracic and/or thoraco-abdominal (Extent I-V) and juxta/para-renal/short-neck aneurysm requiring the implantation of a thoracic and/or thoraco-abdominal fenestrated/branched aortic endograft with delivery system introducer sheath diameter equal or larger than 18 Fr (6 mm).

• Hostile iliac access was defined in the presence of:

‣ Heavily circumferential calcified iliac arteries

⁃ Inner diameter ≤ 6 mm

⁃ Severe stenosis (\> 50%; \> 2.5 m/s peak velocity; absence of triphasic duplex signal in ipsilateral common femoral artery)

• We will accept the following presentations of aneurysm:

‣ urgent cases,

⁃ elective,

⁃ symptomatic

⁃ and fast growing.

• The repair was performed using Shockwave™ before the introduction of the main endograft. The iliac procedures can be accompanied by angioplasty and/or stent and stent-graft positioning.