Poor oversizing of aortic stent-grafts is associated with high risk of type IA endoleak after endovascular repair of aortic aneurysms with wide necks.

Objective The aim of the study was to investigate the performance of endovascular aortic aneurysm repair (EVAR) with suprarenal fixation endografts in wide necks for intact abdominal aortic aneurysms (iAAA). Methods Anatomical data of the treated iAAAs, acquired from a thin slice computed tomography angiography (CTA) of the abdomen with 3‑dimentional reconstructions preoperatively and postoperatively, were evaluated. A statistical analysis comparing the anatomical characteristics of the aneurysm neck according to the presence of an endoleak was conducted using the SPSS Statistics package version 29. Results Between January 2020 and October 2024, 114 patients (105, 92.1% males, median age 75 years) with iAAAs underwent EVAR, most of them (83) with Endurant II/IIs stent-graft (Medtronic, Santa Rosa, US) and of them 15 had a wide neck (28 mm or more). In a multivariate logistic regression analysis the presence of a wide neck had a statistically significant association with the development of a type Ia endoleak (odds ratio, OR 12.961, p = 0.025). A type Ia endoleak was present in 2 of these patients in the first 30 postoperative days. In these 2 patients the oversizing percentage of the proximal landing zone was significantly lower compared to the patients with a wide neck without type Ia endoleak (median oversizing 11.3%, range 6.6-16% vs. 20%, range 15-25%, p = 0.019). The endoleak was persistent in a follow-up period of 18 months. Conclusion The use of EVAR with suprarenal fixation endografts in wide infrarenal necks is safe but in the case of poor oversizing, there is a significant risk for development of a persistent type Ia endoleak.