Association of Proximal Neck Angulation and Diameter With Endoleak After Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms

BACKGROUND: Abdominal aortic aneurysm (AAA) is a life-threatening aortic dilation with high rupture mortality. Endovascular aneurysm repair (EVAR) is the preferred minimally invasive treatment, but post-EVAR endoleaks remain a major challenge. AIMS: To investigate the predictive value of suprarenal angle, infrarenal angle, and proximal neck diameter for endoleak following EVAR in AAA patients and their relationships. METHODS: In this retrospective study, 643 consecutive patients undergoing elective EVAR for non-ruptured AAA were grouped into endoleak (n = 179) and non-endoleak (n = 464) groups. For endoleak distribution, type Ia accounted for 10.06% (n = 18), type Ib 4.47% (n = 8), type II 64.25% (n = 115), type III 14.53% (n = 26), type IV 2.79% (n = 5), and type V 3.91% (n = 7). The association between potential predictors and endoleak of any type and the predictive value of suprarenal/infrarenal angle and proximal neck diameter were assessed using logistic analyses and ROC curves. RESULTS: Maximum aneurysm diameter, suprarenal angle, infrarenal angle, and proximal neck diameter were independent predictors for post-EVAR endoleak of any type. The AUCs of suprarenal angle, infrarenal angle, and proximal neck diameter were 0.647, 0.691, and 0.801, respectively. The optimal clinically rounded cut-off values were > 36° (sensitivity: 0.726, specificity: 0.500), > 58° (sensitivity: 0.514, specificity: 0.788), and > 22 mm (sensitivity: 0.704, specificity: 0.761). Combined prediction yielded a superior AUC of 0.851 (sensitivity: 0.816; specificity: 0.746). Greater proximal neck angulation and larger proximal neck diameter increased endoleak risk. CONCLUSION: Suprarenal angle, infrarenal angle, and proximal neck diameter are independent predictors of post-EVAR endoleak. Their combination demonstrates high predictive performance, suggesting that an integrated anatomical assessment can improve preoperative risk stratification.