Experience with a Large-Bore Vascular Closure Device in Patients Undergoing a Percutaneous Endovascular Aneurysm Repair (EVAR): A Multicentre Study

Purpose: Endovascular aneurysm repair (EVAR) is the preferred treatment for infrarenal aortic aneurysms, offering lower perioperative morbidity and mortality compared to open surgery. Common femoral artery (CFA) access can be achieved percutaneously or through surgical cutdown, with a percutaneous approach gaining more and more popularity. The MANTA vascular closure device (VCD), a collagen plug-based device, has shown promising results in transcatheter aortic valve replacement, but data on its use in percutaneous EVAR (pEVAR), particularly in obese patients, remain limited. Material and Methods: This retrospective study included all patients who underwent pEVAR from October 2018 to December 2022 across three Dutch hospitals and in whom the MANTA VCD has been applied. Patient demographics, perioperative characteristics, and clinical outcomes were recorded. Subgroup analysis was performed based on body mass index (BMI), comparing outcomes in obese (BMI ≥ 30) and non-obese (BMI < 30) patients. Technical success and access site complications were primary and secondary outcomes, respectively. Results: A total of 549 patients (mean age 75.16 ± 7.09 years, 88.9% male) were included, with 140 classified as obese. The MANTA VCD was used in 1024 CFAs. Overall technical success, defined as vascular closure with patent CFA, without requiring immediate surgery, was 98%, with a 3.1% complication rate, primarily due to closure failure. In obese patients, technical success was 98.9%, with a 1.5% complication rate, showing comparable outcomes to non-obese patients. Conclusion: The MANTA VCD is effective and safe for CFA closure in pEVAR, including in obese patients. Given rising obesity rates, the favorable outcomes in this population are encouraging and suggesting a broader applicability in large-bore percutaneous procedures.