[Outcomes of suture-mediated vascular closure device in the closure of left brachial artery access site after thoracic endovascular aortic repair].

OBJECTIVE

To evaluate the feasibility and safety of the suture-mediated vascular closure device in the closure of the left brachial artery access site after thoracic endovascular aortic repair (TEVAR).

METHODS

Data from 91 patients receiving TEVAR with left brachial artery puncture from January 2021 to May 2023 were retrospectively collected and analyzed. In 27 cases whose brachial artery was over 5 mm, a suture-mediate vascular closure device (Perclose ProGlide, Abbott) was used to deal with the left brachial artery access, and in the other 64 cases with brachial artery < 5 mm, manual compression was used. The primary outcomes were the incidence of perioperative access-related complications and long-term outcomes.

RESULTS

In the suture-mediate device group, the access-site compression time was significantly reduced than that in the manual compression group (P < 0.001). The proportion of discomforts, such as numbness, pain, and swelling of the compression-related limbs was significantly lower than that in the compression-alone group (3.70% vs. 42.19%, P < 0.001). One case with brachial artery access-related complications occurred in the suture-mediate device group during hospitalization, which was acute brachial artery occlusion and required reinterventions. In the manual compression group, 4 cases of brachial artery puncture point complications occurred during hospitalization, including 3 cases of pure hematoma with conservative management and 1 case of pseudoaneurysm requiring reintervention. There was no significant difference in the incidence of early puncture point complications between the two groups (3.70% vs. 6.25%, P=0.625). During an average follow-up of (14±6) months, no access-related complications of the left brachial artery occurred.

CONCLUSION

It is effective to use the suture-mediated vascular closure in the left brachial artery access site after TEVAR, and the long-term effect is satisfactory. For patients with >5 mm brachial artery, it is reasonable to use suture-mediated vascular devices to deal with brachial artery access.