Risk Prediction With a Type Ia-Oriented Proximal Neck Anatomic Severity Grading Score After EVAR
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Hakkı Zafer Işcan1, Emre Külahcioğlu2, Bahadır Aytekin1
1Ankara Bilkent City Hospital, Department of Cardiovascular Surgery, Ankara-TURKEY.
Background:
We developed an exploratory Type Ia-oriented proximal neck Anatomic Severity Grading Score (Type Ia-ASGS) and assessed its association with postoperative type Ia endoleak after endovascular aneurysm repair (EVAR).
Methods:
We analyzed 304 elective standard EVAR patients treated during 2016-April 2024 with an Ankura endograft (Lifetech). Neck measurements were proximal diameter (A), distal diameter (B), and centerline length (C). The score assigned 1 point each for C ≤15 mm, max(A, B) >28 mm, and B - A ≥3 mm, and 2 points each for angulation >60° and calcification. The theoretical range was 0-7; weights reflected observed univariable associations.
Results:
Mean clinical and imaging follow-up was 27.6 ± 3.2 months, with final follow-up in June 2026. Type Ia endoleak occurred in 14/304 patients (4.6%). Observed event proportions were 1.2%, 2.8%, and 28.1% in exploratory low (0-1), intermediate (2-3), and high (≥4) score categories (p < 0.001). Each point was associated with greater odds of type Ia endoleak (odds ratio, 2.78; 95% confidence interval, 1.80-4.29). Apparent area under the curve was 0.859 (bootstrap 95% confidence interval, 0.750-0.943). Individual event and censoring dates were unavailable for time-to-event analysis.
Conclusions:
The Type Ia-ASGS was associated with postoperative type Ia endoleak in this derivation cohort. Its heuristic weights and exploratory categories require independent validation before clinical use.