Hostile Neck Index is a Novel and Strong Predictor of Type I Endoleak Development After Endovascular Aortic Repair for Abdominal Aortic Aneurysm

Serdar Badem; Mustafa Selcuk Atasoy

doi:10.1016/j.avsg.2024.12.047

Hostile Neck Index is a Novel and Strong Predictor of Type I Endoleak Development After Endovascular Aortic Repair for Abdominal Aortic Aneurysm

Ann Vasc Surg. 2024 Dec 25:112:113-120. doi: 10.1016/j.avsg.2024.12.047. Online ahead of print.

Authors

Serdar Badem¹, Mustafa Selcuk Atasoy²

Affiliations

¹ Department of Cardiovascular Surgery, Bursa City Hospital, Bursa, Turkey. Electronic address: [email protected].
² Department of Cardiovascular Surgery, Bursa City Hospital, Bursa, Turkey. Electronic address: [email protected].

PMID: 39725292
DOI: 10.1016/j.avsg.2024.12.047

Abstract

Background: This study aimed to investigate the predictive value in the development of type I endoleak in patients undergoing elective endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).

Methods: Clinical and radiological imaging data of 105 patients who underwent EVAR procedure due to AAA between August 2019 and May 2024 were evaluated. The patients were divided into 2 groups according to whether or not periprocedural type I endoleak developed; as the nonendoleak group (n = 82) and endoleak group (n = 23). The patients' preprocedural demographic and clinical characteristics as well as periprocedural data were compared between the groups. After univariate analyses, multivariate logistic regression analysis was performed to determine independent predictors of endoleak development of perioperative mortality and receiver operating characteristic curve analysis was performed to determine the cut-off values of the identified endoleak predictors.

Results: When the preprocedural baseline demographic and clinical characteristics of the groups were compared; the mean ages in the nonendoleak group and endoleak group were found to be 73.0 ± 8.9 and 72.0 ± 6.9 years, respectively. The mean values of aortic neck diameter, aortic neck angulation, and hostile neck index (HNI) were found to be significantly higher, while the mean value of aortic neck length was found to be significantly lower in endoleak group compared to nonendoleak group. In logistic regression analysis, only HNI was found to be an independent predictor of type I endoleak. To predict endoleak development, an optimal cut-off value of 60.95 was determined for HNI with 95.7% sensitivity and 61.0% specificity in receiver operating characteristic curve analysis (area under the curve = 0.755, 95% confidence interval = 0.657-0.852).

Conclusions: This study revealed, for the first time in the literature, that high HNI levels significantly and independently predicted the development of periprocedural type I endoleak in patients undergoing EVAR procedure for AAA.