Mid-term outcomes of a hybrid suture- and plug-based closure strategy for large-bore access haemostasis after endovascular aortic procedures: a multicentre cohort study

Reliable haemostasis of large-bore (16–24 Fr) femoral access sites remains crucial for endovascular aortic procedures. Although the hybrid suture- and plug-based closure strategy is increasingly used, its mid-term clinical outcomes and imaging-based vascular changes remain incompletely characterised. This retrospective review of a prospectively collected multicentre database included consecutive patients who underwent endovascular aortic procedures between January 2022 and July 2023, had at least 24 months of follow-up, and received hybrid closure strategy. Analyses were primarily performed at the access level, with patients comprising the clinical cohort. Primary endpoints were technical success, and short- (≤ 30 days) and mid-term (≥ 24 months) access-related complications. Imaging-based changes in vessel diameter, peak systolic velocity, and calcification were assessed. The cohort comprised 154 patients and 212 femoral access sites (89.6% male; mean age, 68.6 ± 11.8 years). Mean follow-up was 31.7 ± 4.9 months and mean sheath size was 20.3 ± 2.3 Fr. Immediate technical success was 97.6% (207/212), achieving 100% after deployment of an additional ProGlide device. Short-term complications occurred in 9 of 212 access sites (4.2%), including minor bleeding ( n = 6), pseudoaneurysm ( n = 2), and asymptomatic stenosis ( n = 1). No major or mid-term complications were observed. While vessel diameter, peak systolic velocity, and anterior wall calcification incidence remained stable, the access calcification score increased significantly from baseline to final follow-up (0.96 ± 1.03 vs. 1.33 ± 1.06, p < 0.001). The hybrid closure strategy may be feasible with high technical success, low short-term complication rates, and no detected mid-term events.