[Is there still a role for manual deployment techniques in the era of fenestrated/branched endovascular aortic repair? Normative boundaries and practical value in the management of hostile aortic landing zones].

Standard endovascular aortic repair has been widely used for the treatment of abdominal aortic aneurysms and selected complex aortic diseases because of its minimally invasive nature, rapid recovery, and favorable perioperative safety profile. However, in hostile aortic landing zones characterized by a short neck, severe angulation, conical neck configuration, mural thrombus, or circumferential calcification, standard endovascular repair remains associated with inadequate proximal apposition, type I endoleak, endograft migration, and secondary intervention. Manual deployment techniques, including the push-up technique, reverse slider technique, Kabedon technique, and stepwise controlled deployment, may improve endograft axial alignment, proximal edge positioning, and local wall apposition to some extent; however, their role is mainly limited to optimization of the deployment process and cannot replace the principle of a durable sealing zone. This review summarizes the anatomical characteristics of hostile aortic landing zones, the mechanisms and clinical evidence of manual deployment techniques, the standardized value of fenestrated/branched endovascular aortic repair and physician-modified endografts, adjunctive fixation and intraoperative bailout techniques, and application scenarios in emergency repair of ruptured abdominal aortic aneurysms. The aim is to provide a practical reference for rational selection between optimized deployment of standard endografts and complex sealing-zone reconstruction in complex endovascular aortic repair.