Hostile neck index is a novel and strong predictor of type I endoleak development after endovascular aortic repair for abdominal aortic aneurysm.

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 two groups according to whether or not periprocedural type I endoleak developed; as the non-endoleak 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 ROC 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 age in the non-endoleak group and endoleak group was found to be 73.0±8.9 and 72.0±6.9 years, respectively. The mean values of aortic neck diameter (AND), aortic neck angulation (ANA) and hostile neck index (HNI) were found to be significantly higher, while the mean value of aortic neck length (ANL) was found to be significantly lower in endoleak group compared to non-endoleak group. In logistic regression analysis, only HNI was found to be an independent predictor of type I endoleak. In order 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 ROC curve analysis (AUC=0.755, 95%CI=0.657-0.852).

Conclusion: 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.