Background/Objectives: Abdominal aortic aneurysm (AAA) repair is a prophylactic intervention aimed at preventing rupture. As the population ages, surgical decision-making becomes increasingly complex, especially in older and frailer patients. Imaging biomarkers, such as psoas muscle area (PMA) and density (PMD), have been proposed as surrogates for frailty and potential predictors of surgical outcomes. However, their clinical utility remains uncertain. Methods: In this retrospective, single-center study, we evaluated 199 patients who underwent elective AAA repair between 2015 and 2019. Preoperative computed tomography angiography (CTA) was used to measure PMA and PMD at the level of the third lumbar vertebra. Lean psoas muscle area (LPMA) was calculated as the product of PMA and PMD. Sarcopenia was defined as the lowest tertile of each measurement. Outcomes were assessed using Fisher’s exact test, Kaplan–Meier survival analysis, and logistic regression. Results: No significant associations were found between PMA, PMD, or LPMA and early or late postoperative complications or mortality. Conclusions: Psoas muscle indices, measured on routine CTA scans, do not reliably predict postoperative outcomes in AAA patients. These findings suggest that further studies integrating broader clinical and functional assessments are needed to improve risk stratification and inform preoperative decision-making in this patient population.

Objectives: To analyze the effect of abdominal aortic aneurysm (AAA) diameter on late complication occurrence and survival in patients following endovascular aneurysm repair (EVAR). Methods: The study was a retrospective cohort analysis with a prospective follow-up of 176 patients diagnosed with unruptured AAA who underwent EVAR from 2016 to 2024. Preoperative computed tomography (CT) images were used to measure maximal aneurysm diameter. Prospective follow-up data were collected post-EVAR at 1 month, 6 months, and annually through clinical evaluations and imaging studies. The mean follow-up duration was 26 months. For statistical purposes, the group was divided into tertiles based on aneurysm size. This study was intentionally focused on aneurysm size as an isolated imaging parameter, and did not incorporate other known predictors of complications, such as neck morphology or device-related variables. As such, key limitations include the single-center design, relatively small sample size, and lack of data on anatomical features beyond maximum diameter. Results: Kaplan–Meier survival analysis demonstrated that patients in the highest tertile of aneurysm size experienced significantly higher rates of long-term adverse outcomes compared to those in the lower two tertiles, both in terms of late complications (log-rank p = 0.049) and all-cause mortality at 36 months (p = 0.022). In multivariate logistic regression, the occurrence of late complications was independently associated with symptomatic presentation (p = 0.003, OR = 3.616, 95% CI: 1.533–8.529) and acute admission (p = 0.033, OR = 0.345, 95% CI: 0.130–0.916). The largest aneurysms were significantly associated with late endoleak (p = 0.041, OR = 5.365, 95% CI: 1.071–26.871). Conclusions: This study demonstrates that AAA size is an independent predictor of both late complications and long-term survival following EVAR. Patients with larger aneurysm diameters experienced significantly higher rates of late complications and reduced overall survival.