Effectiveness of the MANTA Vascular Closure Device for Endovascular Aneurysm Repair in the Obese: a Prospective Pilot Audit

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.

A Comparative Analysis of the Early and Late Complication Rates and the Effect of Calcification on the Efficacy of MANTA and ProGlide Vascular Closure Devices

Introduction The Perclose ProGlide and, more recently, MANTA Large-Bore Closure Device are commonly used vascular closure devices (VCDs) for managing large-bore vascular access haemostasis. The extent of calcification in the common femoral artery (CFA) plays a crucial role in choosing between these devices. ProGlide may face challenges with anterior calcification, while MANTA may have issues with posterior calcification. Our study compared their effectiveness, adjunct usage, calcification impact and early/late complications. Methods A retrospective analysis of procedures involving large-bore CFA access from 2017 to 2022 was conducted. Closure was grouped according to VCD as Group A (ProGlide) and Group B (MANTA). Calcification was designated as anterior and posterior and combined on pre-operative computed tomography angiography along 10 mm segments with 0.625 mm slice thickness. The success of haemostasis was graded as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts) and Grade 3 (failed haemostasis needing rescue); Grades 1 and 2 were pooled as successful haemostasis. Statistical analysis was undertaken in Minitab 21 for Windows, particularly analysing calcification and its impact on the success of haemostasis. Results We evaluated 370 large-bore CFA accesses, distributed across two groups: Group A(64.9%, n=243) and Group B (35.1%, n=127), for a total of 205 endovascular procedures (93.1% (191) EVAR and 5.3% (11) TEVAR). The mean age was 74.9±8 years, predominantly males (88.2%, n=181). The average body mass index (BMI) was 28±5.8, with 20.9% (43) individuals having diabetes and 18.5% (37) current smokers. The mean sheath size OD was 16±2.5, with 4.5% (11) re-do groins in Group A and 6.2% (8) in Group B. Successful haemostasis was achieved in 91.8% (n=223) in Group A (44.8%, n=109 Grade 2) and 90.5% (n=115) in Group B (21%, n=27 Grade 2). Rescue operations were needed in 8.2% (20) in Group A and 9.1% (12) in Group B. Pseudoaneurysms developed more commonly in Grade 2 haemostasis with 9.9% (11) in Group A and 1.6% (2) in Group B (p=0.3). Anterior calcification was observed in 14.8% (36) in Group A and 18.8% (24) in Group B. In comparison, posterior calcification was present in 62.5% (152) in Group A and 66.9% (85) in Group B. Notably, calcification did not significantly impact haemostasis (p=0.79). Additional VCD deployment was necessary due to device failure in 4.5% (11) cases in Group A and 1.5% (2) cases in Group B. Conclusion The overall success rate was comparable between the two groups. However, Group A required more adjuncts to achieve successful haemostasis. The site of calcification did not impact the efficacy of closure devices. Pseudoaneurysm formation was more frequent when adjuncts were needed.