Abstract

Aim: This study sought to investigate possible anatomical and clinical determinants linked to the occurrence of type I endoleak after endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysm (AAA).
Material and Methods: This was a retrospective, single-center cohort study comprising 133 patients who underwent elective EVAR between 2019 and 2024. Patients were categorized according to the presence of type I endoleak (n = 28) or absence (n = 105). Baseline characteristics, comorbidities, and preoperative imaging findings were analyzed. Significant factors influencing development of type I endoleak were identified using multivariable logistic regression, and diagnostic performance was assessed with receiver operating characteristic (ROC) analysis.
Results: Patients who developed type I endoleak were older (p = 0.048). They also exhibited significantly larger aortic neck diameters, greater neck angulation, shorter neck lengths, and a higher prevalence of neck calcification. Multivariable analysis confirmed neck diameter (OR = 1.240, p = 0.001), neck length (OR = 0.871, p = 0.002), neck angulation (OR = 1.077, p = 0.007), and calcification (p = 0.041) as significant predictive factors. ROC analysis identified 26.5 mm and 58.5° as optimal cut-off values for neck diameter and angulation, respectively.
Conclusion: Adverse proximal neck morphology plays a key role in the development of type I endoleak following EVAR. Careful preoperative assessment of these anatomical features may enhance risk stratification and improve EVAR outcomes.

Key words: Endovascular aneurysm repair, abdominal aortic aneurysm, type I endoleak, aortic neck anatomy, proximal neck morphology