Background: The treatment of infrarenal abdominal aortic aneurysms is carried out endovascularly in approximately 75% of cases. Open surgical treatment is a rarity. A short, wide, conical or angulated aneurysmal neck (hostile neck) still poses a technical challenge in the treatment of AAA. Objective: Presentation of treatment options for the complicated hostile neck. Discussion on the pros and cons of different treatment strategies. Material and methods: Non-systematic PubMed-based search and analysis of recent literature and registry data. Results: The currently established minimally invasive endovascular techniques and devices open up new horizons for vascular surgeons in the treatment of complex infrarenal hostile necks. Several methods are available to extend the sealing zone for EVAR (endovascular aortic repair) or EVAS (endovascular aortic sealing) in hostile Necks. The implantation of custom-made fenestrated stent grafts is considered the therapy of choice for elective patients presenting with hostile neck morphology. In comparison less well evaluated but technically less demanding methods for treatment of hostile neck are so-called parallel grafts (chimney, snorkel) and funnel techniques as well as simple screw fixation. In addition, open surgical treatment still has an undisputed value due to its excellent long-term results. Conclusion: Complementary treatment approaches are now available for treatment of the difficult aneurysma neck in juxtarenal and pararenal AAA pathologies. A conclusive statement on the value of the various methods is not possible due to a sparsity of published data. The endovascular treatment procedure is the method of choice while open surgery is still possible but is of subordinate importance.