Pledget Reinforcement and Tractional Compression as Adjunctive Techniques for Suture Mediated Closure (SMC) in percutaneous Endovascular Aneurysm Repair (pEVAR): A Retrospective Observational Cohort Study.

Abstract Introduction Percutaneous endovascular aneurysm repair (pEVAR) are commonly utilised and require the use of suture-mediated closure (SMC) devices to ensure adequate femoral artery haemostasis. Despite the use of such devices, puncture related complications remain relatively common. We introduced two new adjuncts (pledget reinforcement and tractional compression) along with SMC to reduce such puncture related complications. The aim of the study was to assess the efficacy and safety of the new adjunct techniques. Method This retrospective observational cohort study examines the impact of two adjunctive techniques on puncture related complications compared to the previous year data prior to this new introduction of adjunct techniques. Results 61 percutaneous femoral punctures (in 31 patients) utilising adjunct techniques for closure ( Adjunct Group ) were retrospectively compared to 89 punctures (in 46 patients) closed with standard SMC technique ( Standard Group ). The use of adjunctive techniques led to a significant reduction in overall puncture related complications (3/61 (4.9%) vs. 20/89 (22.5%), p=0.0106), and the need for emergent surgical repair following failed haemostasis (2/61 (3.3%) vs. 13/89 (14.6%), p=0.037). Conclusions These novel adjunctive techniques (pledget reinforcement and tractional compression) of SMC for pEVAR reduces puncture related complications and increase the confidence to offer percutaneous techniques for more patients.