Neutrophil-Lymphocyte Ratio as a Predictor of Persistent Type 2 Endoleak after Endovascular Aneurysm Repair

Objectives: One of the important postoperative complications of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is type 2 endoleak (T2EL). However, there is no well-established biomarker. We aimed to evaluate the validity of the neutrophil-lymphocyte ratio (NLR) as a predictor of T2EL. Methods: Data were retrospectively collected from 146 patients who underwent EVAR for AAA at our institution between April 1, 2008 and March 31, 2021. Within 90 days before surgery, preoperative NLR was calculated from the same blood sample. The receiver operating characteristic curve (ROC) was used to determine the cutoff NLR values for persistent T2EL. Univariate and multivariate analyses were performed. Results: Compared with patients without persistent T2EL, those who had persistent T2EL had lower preoperative NLR (P = 0.041), based on a cutoff value of 1.918, and the entire group was then divided into two groups based on these values for comparison. Univariate analysis showed significant differences in NLR, the white blood cell (WBC) count, the percentage of mural thrombus of aneurysm, history of the hypertension, follow-up term, and aneurysm diameter at final follow-up. Multivariate analysis showed that NLR and AAA diameter on the last follow-up were significantly associated with T2EL persistence. Conclusions: Preoperative low NLR can be a useful predictor of postoperative persistent T2EL.