Clinical outcomes and cost analysis of plug-based versus suture-based vascular closure devices for percutaneous large bore aortic procedures

<b></b> <i>Background:</i> To compare the clinical outcomes and the costs of the plug-based- versus suture-based vascular closure device following large-bore percutaneous aortic procedures. <i>Materials and methods:</i> This single-centre retrospective analysis included 68 consecutive patients undergoing endovascular aortic procedures between January 2024 and May 2025. Femoral artery closure was achieved using either the MANTA (Teleflex, Wayne, Pennsylvania) or Perclose ProStyle (Abbott Vascular, Abbott Park, Il) vascular closure device. Procedural details, anatomical parameters, and access-site outcomes were analysed. The primary endpoint was technical success. Secondary endpoints included bleeding, vessel occlusion, pseudoaneurysm, access-site thrombosis, surgical conversion, and device-related cost per access site. <i>Results:</i> Sixty-eight patients with 111 femoral access sites (71 MANTA, 40 Perclose ProStyle) were included. No differences were observed between groups regarding aortic pathology, access vessel diameter, or calcification severity. Technical success was high in both groups (97.5% Perclose ProStyle vs. 93.0% MANTA; p = .312). Access-site complications occurred more frequently in the MANTA group, including all pseudoaneurysms (2.8%) and most surgical conversions (7.0% vs. 2.5%), although differences were not statistically significant. No access-site thrombosis was observed. Mean device-related cost per access site was significantly higher for MANTA than for Perclose ProStyle (€466 vs. €290; p = .001). <i>Conclusions:</i> Both MANTA and Perclose ProStyle devices achieved high rates of successful large-bore femoral closure. However, the suture-based ProGlide system was associated with lower cost and fewer access-site complications. Given the retrospective design and operator-driven device selection, these findings should be interpreted with caution.