Clinical outcomes and cost analysis of plug-based versus suture-based vascular closure devices for percutaneous large
Kareem El Sherbiny1, Natasha Hasemaki2, Theodosios Bisdas3
1Vascular and Endovascular Surgery Unit, Mathias Spital Rheine, Germany.
Insights
Suture-based vascular closure devices, like Perclose ProStyle, show lower costs and fewer complications than plug-based MANTA devices for large-bore aortic procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Access Management
Background:
- Large-bore percutaneous aortic procedures require reliable femoral artery closure.
- Vascular closure devices (VCDs) aim to minimize complications and facilitate ambulation.
- Comparing plug-based (MANTA) and suture-based (Perclose ProStyle) VCDs is crucial for optimizing patient care.
Purpose of the Study:
- To compare clinical outcomes and costs of plug-based versus suture-based VCDs after large-bore percutaneous aortic procedures.
- To evaluate technical success and access-site complication rates between the MANTA and Perclose ProStyle devices.
Main Methods:
- Single-center retrospective analysis of 68 patients undergoing endovascular aortic procedures.
- Femoral artery closure utilized either MANTA or Perclose ProStyle VCDs.
- Analysis included procedural details, anatomical parameters, and access-site outcomes (technical success, bleeding, occlusion, pseudoaneurysm, thrombosis, conversion, cost).
Main Results:
- High technical success rates for both devices (97.5% Perclose ProStyle vs. 93.0% MANTA).
- The MANTA group experienced more access-site complications, including pseudoaneurysms (2.8%) and surgical conversions (7.0% vs. 2.5%), though not statistically significant.
- Mean device-related cost was significantly higher for MANTA (€466) compared to Perclose ProStyle (€290).
Conclusions:
- Both MANTA and Perclose ProStyle achieve high success rates for large-bore femoral closure.
- The suture-based Perclose ProStyle system demonstrated lower costs and a trend towards fewer access-site complications.
- Findings should be interpreted cautiously due to retrospective design and operator-driven device selection.
Abstract:
Background: To compare the clinical outcomes and the costs of the plug-based- versus suture-based vascular closure device following large-bore percutaneous aortic procedures. Materials and methods: This single-centre retrospective analysis included 68 consecutive patients undergoing endovascular aortic procedures between January 2024 and May 2025. Femoral artery closure was achieved using either the MANTA (Teleflex, Wayne, Pennsylvania) or Perclose ProStyle (Abbott Vascular, Abbott Park, Il) vascular closure device. Procedural details, anatomical parameters, and access-site outcomes were analysed. The primary endpoint was technical success. Secondary endpoints included bleeding, vessel occlusion, pseudoaneurysm, access-site thrombosis, surgical conversion, and device-related cost per access site. Results: Sixty-eight patients with 111 femoral access sites (71 MANTA, 40 Perclose ProStyle) were included. No differences were observed between groups regarding aortic pathology, access vessel diameter, or calcification severity. Technical success was high in both groups (97.5% Perclose ProStyle vs. 93.0% MANTA; p = .312). Access-site complications occurred more frequently in the MANTA group, including all pseudoaneurysms (2.8%) and most surgical conversions (7.0% vs. 2.5%), although differences were not statistically significant. No access-site thrombosis was observed. Mean device-related cost per access site was significantly higher for MANTA than for Perclose ProStyle (€466 vs. €290; p = .001). Conclusions: Both MANTA and Perclose ProStyle devices achieved high rates of successful large-bore femoral closure. However, the suture-based ProGlide system was associated with lower cost and fewer access-site complications. Given the retrospective design and operator-driven device selection, these findings should be interpreted with caution.
