Background and Aims Abdominal aortic aneurysm (AAA) is a common arterial dilation disease in vascular surgery, with aneurysm rupture being its most serious complication, often leading to fatal hemorrhage and posing a severe threat to patients' lives. Endovascular aneurysm repair (EVAR), due to its minimally invasive nature, safety, and rapid recovery, has become the preferred treatment for AAA. However, endoleak, a complication unique to EVAR, remains a major clinical challenge. Persistent endoleak can lead to sustained high pressure within the aneurysm sac, increasing the risk of continued expansion and rupture. It is one of the main causes of the high reintervention rate following EVAR. In particular, the treatment strategy for type Ⅱ endoleaks remains controversial. This study was conducted to evaluate the clinical value of selective sac embolization via the iliac approach combined with standard EVAR in managing intraoperative immediate endoleaks. Methods The clinical data of AAA patients with a risk of endoleak who underwent standard EVAR at the First Hospital of China Medical University between March 2023 and September 2024 were retrospectively collected. Patients were divided into an intervention group ( n=42) and a non-intervention group ( n=32) based on whether selective sac embolization via the iliac approach was performed during operation. General clinical data, preoperative anatomical characteristics of the AAA, surgical details, and postoperative follow-up results were compared between the two groups. Results There were no statistically significant differences between the two groups in terms of age, sex, anatomical features, rupture rate, or off-label use (all P>0.05). The technical success rate during surgery was 100% in both groups. One patient in the intervention group experienced transient sigmoid colon ischemia after operation, which resolved with conservative treatment. The mean follow-up period was (6.49±4.68) months. The proportions of aneurysm sac shrinkage, stability, and enlargement in the intervention group were 40.5%, 57.1%, and 2.4%, respectively, compared to 59.4%, 40.6%, and 0.0% in the non-intervention group, with no statistically significant differences (all P>0.05). The incidence of endoleak during follow-up was also comparable between the two groups ( P>0.05). Conclusion For intraoperative endoleaks during standard EVAR, selective sac embolization via the iliac approach is a technically simple and safe method that provides short-term outcomes comparable to those in patients without intraoperative endoleaks. Its long-term efficacy warrants further investigation through extended follow-up.