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.