Percutaneous system for access-site closure beneficial vs. surgical cutdown

Darren Schneider

LAS VEGAS — Percutaneous closure of large-bore arterial access sites was associated with positive outcomes compared with surgical cutdown, according to data presented at VIVA 17.

The percutaneous closure device (Perclose ProGlide , Abbott Vascular) was associated with fewer blood transfusions and infections, lower mortality and shorter length of stay compared with surgical cutdown, Darren Schneider, MD, associate professor and chief of vascular and endovascular surgery at the NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, said here.

Schneider and colleagues conducted a retrospective study comparing the two approaches in patients who underwent endovascular abdominal aortic aneurysm repair, thoracic endovascular aortic repair, balloon aortic valvuloplasty or transcatheter aortic valve replacement between 2013 and April 24, 2017.

From the IBM Explorys database of approximately 55 million patients, Schneider and colleagues matched 757 patients who underwent a procedure using the percutaneous closure device and 757 patients who underwent one using surgical cutdown. Patients (mean age, 77 years; 67% men) were matched based on age, sex, index procedure, index year, baseline blood transfusion and presence of peripheral vascular disease. Analyses were controlled for anticoagulant use, atherosclerosis, cancer, chronic respiratory disease, MI, stroke and blood transfusion.

“This is one of the first vascular applications of using the IBM Explorys research database from IBM Watson Health,” Schneider said at a press conference. “It includes advanced longitudinal data, from which you can get things that are not specifically coded for, like percutaneous closure, using the different methodologies they have for identifying these patients. We were able to select cases where somewhere in the record there was a model number for the Perclose device, and the controls were patients we knew had surgical cutdown, and there was no Perclose model number listed in the record.”

At index hospitalization, 9.5% of the percutaneous group required blood transfusion vs. 35.7% of the surgical group (P < .001), 1.8% of the percutaneous group had hemorrhage vs. 3% of the surgical group (P = .134) and 15.6% of the percutaneous group had an infection vs. 22.2% of the surgical group (P = .001), according to the researchers.

At 30 days, blood transfusion (10.7% vs. 35%; P < .001) and infection (21.6% vs. 31.2%; P < .001) remained less common in the percutaneous group, and hemorrhage was lower in the percutaneous group (1.7% vs. 3.7%; P = .026), Schneider said.

After multivariable adjustment, at index, percutaneous closure was associated with lower odds of blood transfusion (OR = 0.2; 95% CI, 0.15-0.27) and infection (OR = 0.59; 95% CI, 0.44-0.79), but not hemorrhage (OR = 0.67; 95% CI, 0.32-1.39) vs. surgical cutdown, whereas at 30 days, percutaneous closure had lower odds of all three outcomes (OR for transfusion = 0.21; 95% CI, 0.15-0.28; OR for hemorrhage = 0.45; 95% CI, 0.22-0.94; OR for infection = 0.57; 95% CI, 0.44-0.73), he said.

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In the percutaneous group, compared with the surgical group, mortality was significantly lower at 30 days (1.1% vs. 3%; OR = 0.3; 95% CI, 0.13-0.71) and length of stay was shorter (5.4 days vs. 9 days; OR = 0.57; 95% CI, 0.53-0.62), Schneider and colleagues found.

“We think that Perclose should be considered preferred to surgical cutdown to minimize access-site complications and resource use in appropriate patients,” Schneider said at the press conference. – by Erik Swain

Reference:

Schneider D, et al. Late-Breaking Clinical Trials. Presented at: VIVA 17; Sept. 11-14, 2017; Las Vegas.

Disclosure: The study was funded by Abbott Vascular. Schneider reports he has received honoraria from Abbott Vascular, Boston Scientific and W.L. Gore and Associates; has consulted for Boston Scientific, Cook Medical and W.L. Gore and Associates; and received research funding from Bard Peripheral Vascular, Boston Scientific, Cook Medical, Endologix, Silk Road Medical, W.L. Gore and Associates and Zimmer/Biomet.