Safety and Effectiveness of Single Proglide Vascular Access in Patients Undergoing Endovascular Aneurysm Repair

Abstract Objective To evaluate the safety and effectiveness of single ProGlide use per bilateral access site for Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysms (AAA). Methods A retrospective cohort study was performed for all elective percutaneous EVARs from November 2015-December 2017 at the QEII Health Sciences Centre, Nova Scotia. Exposure of interest was number of ProGlides used per access site, dichotomized into bilateral single ProGlide closure vs non-single ProGlide closure on at least one femoral arteriotomy. Outcomes included Vascular Access Site and Access Related Complications 2 (VARC2) and Bleeding Academic Research Consortium (BARC) criteria. Groups were compared with Fisher exact test, ANOVA or Wilcoxon rank sum, as appropriate. Logistic regression was used to compare the effect of single ProGlide use on VARC2 and BARC. Results A total of 131 cases were included, of which 116 had bilateral single ProGlide for access closure. Baseline characteristics including co-morbidities and smoking status were compared amongst groups. Groups were similar for all characteristics except smoking status, with an increased proportion of former smokers in the non-single ProGlide group. 119 (90.8%) patients had single ProGlide use on the right femoral artery and 121 (92.4%) on the left. 16 (12.2%) patients had ProGlide deployment issues. Median maximal right and left femoral sheath diameters were 16 french [IQR 16-18] and 14 french [IQR 14-16], respectively. Median length of stay was 1 day [IQR 1-1]. VARC2 occurred in 8/131(6.11%) of patients: 6/116 (5.17%) with bilateral single ProGlides and 2/15(13.3%) non-single ProGlides. BARC occurred in 6/131 (4.58%) of patients: 5/116 (4.31%) with bilateral single ProGlides and 1/15 (6.67%) non-single ProGlides. Single ProGlide use was not associated with a difference in VARC2 (OR 0.35, 95%CI 0.64-1.94) or BARC (OR 0.63, 95%CI 0.07-6.79). No patients developed pseudoaneurysms or required repeat intervention for bleeding. Conclusion Single ProGlide use per vascular access site in patients undergoing EVAR is a safe and effective method for access closure with sheath diameters up to and including 16 french.