Work

Anatomical Risk Factors for Technical Failure of the Perclose Vascular Closure Device: A Single-Center Retrospective Study

Year: 2026

Type: article

Abstract: Objectives: Percutaneous large-bore femoral closure with the Perclose device is widely used, but technical failure remains clinically important. We identified anatomical risk factors for technical failure. Methods: We retrospectively analyzed endovascular aortic repair and endovascular therapy procedures using the Perclose device at the common femoral artery (CFA) between April 2020 and March 2025. Preoperative computed tomography (CT) measured CFA diameter, puncture depth, and a calcification score (0-4). Technical failure was defined as failure to achieve hemostasis with the intended deployment. Independent predictors were identified using patient-clustered generalized estimating equations. Results: Among 300 patients (485 limbs), technical failure occurred in 52 limbs (10.7%), of which 75.0% required surgical repair. Independent predictors were a higher calcification score (odds ratio [OR] 2.13 per 1-point increase; 95% confidence interval [CI] 1.37-3.31), an emergency procedure (OR 3.77; 1.55-9.14), a smaller CFA diameter (OR 1.16 per 1-mm decrease; 1.01-1.32), and a shallower puncture depth (OR 1.22 per 5-mm decrease; 1.01-1.47); the area under the curve was 0.72. Conclusions: Technical failure was driven by unfavorable CFA anatomy-heavy calcification, a small diameter, and a shallow puncture depth-and by emergency procedures. Preprocedural imaging assessment is essential; alternative closure or surgical cutdown should be considered in unfavorable or emergent cases.

Source: Annals of Vascular Diseases

DOI: 10.3400/avd.oa.26-00118