488 Comparison of Efficacy Between Suture-Mediated and Plug-Based Vascular Closure Devices Following Endovascular Procedures via Large-Bore Femoral Punctures
A Hakeem, M Najem, A Chaudhuri- Surgery
Abstract
Introduction
Endovascular aneurysm repair is typically performed via large-bore percutaneous femoral access; with haemostasis achieved using vascular closure devices (VCDs). Such VCDs include suture-mediated closure devices like ProGlide or plug-based such as the MANTA. We compared the efficacy of two techniques, early and late complications related to the devices.
Method
We undertook a retrospective analysis of a prospective database of large-bore access procedures from 2017-2022, comparing two groups by VCD used, designated Group A (ProGlide) and Group B (Manta). We classified haemostasis as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts such as pressure dressings) and Grade 3 (failed haemostasis needing rescue). Grades 1 & 2 were considered successful haemostasis. We used Minitab 21 for statistical analysis.
Results
We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A and 131 Group B). The mean age was 74.9±8 (183 males), and the average BMI was 28±5.8. 191 had EVAR and 11 TEVAR. 5% had redo groins (11 Group A and 8 Group B, p = 0.47). The average sheath outer diameter was 16±2.5F. Successful haemostasis was achieved in 91.1% (222 in Group A and 119 in Group B). 8.8% needed a rescue operation (21 in Group A and 12 in Group B, p = 0.86). Pseudoaneurysms developed in 4.8% (n = 18) and were more frequent in Grade 2 haemostasis (11 Group A and 2 Group B, p = 0.058).
Conclusions
The overall success rate was comparable between the two groups. However, ProGlide deployments required more adjuncts to achieve haemostasis. Pseudoaneurysm formation was more frequent with adjuncts.