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

Abstract

To evaluate the safety and effectiveness of single Proglide use per access site for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA). A retrospective cohort study was performed for all elective percutaneous EVARs from November 2015 to December 2017 at the QEII Health Sciences Centre, Nova Scotia. Exposure of interest was number of Proglides used per access site. Outcomes of interest included Vascular Access Site and Access Related Complications 2 (VARC-2) and Bleeding Academic Research Consortium (BARC) criteria. Groups were compared with Fisher exact test, analysis of variance, or Wilcoxon rank-sum tests, as appropriate. Logistic regression was used to compare the effect of single Proglide use on VARC-2 and BARC. A total of 131 cases were included, of which 116 had bilateral single Proglide for access closure. Patient demographic and operative data are presented in Tables I and II, respectively. Groups were similar for all characteristics except smoking status, with an increased proportion of former smokers in the nonsingle Proglide group. There were 119 patients (90.8%) who had single Proglide use on the right femoral artery and 121 (92.4%) on the left. Sixteen patients had Proglide deployment issues (12.2%). VARC2 occurred in 8 of 131 patients (6.11%)—6 of 116 (5.17%) with bilateral single Proglides and 2 of 15 (13.3%) with at least two Proglides on one access site. BARC occurred in 6 of 131 patients (4.58%)—5 of 116 (4.31%) with bilateral single Proglides and 1 of 15 (6.67%) with at least two Proglides on one access site. Single Proglide use was not associated with a difference in VARC-2 (odds ratio, 0.35; 95% confidence interval, 0.64-1.94) or BARC (odds ratio, 0.63; 95% confidence interval, 0.07-6.79). No patients developed pseudoaneurysms or required repeat intervention for bleeding. The median length of stay was 1 day. Single Proglide use per vascular access site in patients undergoing EVAR is a safe and effective method for access closure.Table IBaseline characteristics and comorbiditiesEntire cohort (N = 131)Single Proglide (n = 116)Nonsingle Proglide (n = 15)P valueNo. or median% or IQRNo. or median% or IQRNo. or median% or IQRAge7368-796674-796872-75.318Male sex10680.99380.21386.7.735American Society of Anesthesiologists class.161 22836.42332.9571.4 34558.44361.4228.6 445.1945.7100.0Body mass index2426.9-30.226.924.0-30.225.124.7-28.4.504Comorbidities Coronary artery disease4937.44437.9433.3.785 Hypertension10983.29884.51173.3.280 Chronic kidney disease1612.21512.916.67.693 Pulmonary vascular diseaseDyslipidemiaDiabetes mellitus6448.95648.315100.788IQR, Interquartile range. Open table in a new tab Table IIOperative dataEntire Cohort (n = 131)Single Proglide (n = 116)Nonsingle Proglide (n = 15)P valueNo., median or mean%, IQR or SDNo., median or mean%, IQR OR SDNo., median or mean%, IQR or SDAnesthesia.270 Local10680.99682.71066.7 General2317.61815.5533.3 Local to general21.521.7200.0Surgery length (n = 99)10539.51064195.822.9.375Heparin (n = 114)581418825798192459331579.7950Protamine (n = 108)33.814.233.714.6359.12.7883Sheath size Right1616-181616-181616-18.203 Left1414-161414-161414-14.536IQR, Interquartile range.P values are from Fisher exact test, analysis of variance, or Wilcoxon rank-sum test as appropriate. Open table in a new tab