Antegrade Femoral Puncture Using a Suture-Mediated Closure Device in Infrainguinal Endovascular Interventions.

Background: ProGlide is a suture-mediated vascular closure device (VCD) indicated for retrograde access closure at the common femoral artery (CFA). However, its off-label use for antegrade and/or superficial femoral artery (SFA) access has become common in many practices. This study evaluated the efficacy and safety of ProGlide for femoral artery access closure in patients undergoing antegrade infrainguinal endovascular procedures.

Methods: In this single-center retrospective study, we analyzed data from patients with peripheral arterial disease (PAD) who underwent peripheral angioplasty between January 2017 and December 2023. The inclusion criteria were infrainguinal PAD disease, Rutherford classification 3 to 6, the use of an endovascular approach, and access performed through the ipsilateral antegrade femoral artery. The primary endpoint of the study was to evaluate the efficacy and technical success of the Perclose ProGlide closure device during antegrade percutaneous endovascular procedures. Secondary endpoints included intraoperative and postoperative inguinal and vascular complications.

Results: A total of 301 participants were included in the study. All patients were classified according to the clinical categories of chronic limb ischemia: 111 patients (37%) had severe claudication (class 3) with walking distances of less than 20 meters, 42 patients (14%) had at least one limb with ischemic rest pain (class 4), and 148 patients (49%) had at least one limb with ischemic tissue loss (class 5 or 6). A 6 Fr introducer was used in the majority of cases (88%), with a mean hospital stay of 1.5 ± 0.5 days. Technical success was achieved in 298 patients (99%), and there were no early deaths. A total of 33 hematomas were identified, with 5 patients having major complications. One of these was treated with conservative management, while 4 patients required further interventions.

Conclusions: This retrospective study demonstrated the feasibility and safety of using the ProGlide single VCD for antegrade femoral puncture during infrainguinal endovascular interventions. The safety of its deployment can be further optimized by routinely utilizing ultrasound (US) guidance.