Background To investigate the clinical outcomes of use of a novel off-the-shelf multibranched endovascular stent graft in patients with type Ia endoleak after endovascular aortic repair (EVAR). Methods Patients who received the G-Branch endograft for type Ia endoleak after EVAR at our institution between November 2021 and July 2024 were retrospectively reviewed. The G-Branch endograft system, which has a hybrid configuration comprising 2 inner branches for the celiac axis and superior mesenteric artery and 2 outer branches for the renal arteries, was used in all cases. Follow-up assessments were scheduled at 1, 6, and 12 months after the index procedure and annually thereafter. Results Technical success was achieved in all cases. No deaths, cases of spinal cord ischemia, or other major adverse events occurred within 30 days postprocedure. No type Ia or type III endoleaks were detected during a median follow-up of 24 months. One patient (14.3%) underwent reintervention for type II endoleak. All target vessels remained patent without significant stenosis. No instances of dilatation of the aneurysm sac were observed. Conclusion The G-Branch endograft represents a promising option for management of type Ia endoleak after EVAR, with favorable short-term to medium-term outcomes. A large multicenter study is warranted to confirm our findings.

Acute aortic dissection (AAD) progresses rapidly and is associated with high mortality; therefore, there remains an urgent need for pharmacological agents that can protect against AAD. Herein, we examined the therapeutic effects of cannabidiol (CBD) in AAD by establishing a suitable mouse model. In addition, we performed human AAD single-cell RNA sequencing and mouse AAD bulk RNA sequencing to elucidate the potential underlying mechanism of CBD. Pathological assays and in vitro studies were performed to verify the results of the bioinformatic analysis and explore the pharmacological function of CBD. In a β-aminopropionitrile (BAPN)-induced AAD mouse model, CBD reduced AAD-associated morbidity and mortality, alleviated abnormal enlargement of the ascending aorta and aortic arch, and suppressed macrophage infiltration and vascular smooth muscle cell (VSMC) apoptosis. Bioinformatic analysis revealed that the pro-apoptotic gene PMAIP1 was highly expressed in human and mouse AAD samples, and CBD could inhibit Pmaip1 expression in AAD mice. Using human aortic VSMCs (HAVSMCs) co-cultured with M1 macrophages, we revealed that CBD alleviated HAVSMCs mitochondrial-dependent apoptosis by suppressing the BAPN-induced overexpression of PMAIP1 in M1 macrophages. PMAIP1 potentially mediates HAVSMCs apoptosis by regulating Bax and Bcl2 expression. Accordingly, CBD reduced AAD-associated morbidity and mortality and mitigated the progression of AAD in a mouse model. The CBD-induced effects were potentially mediated by suppressing macrophage infiltration and PMAIP1 (primarily expressed in macrophages)-induced VSMC apoptosis. Our findings offer novel insights into M1 macrophages and HAVSMCs interaction during AAD progression, highlighting the potential of CBD as a therapeutic candidate for AAD treatment.

The morbidity and mortality rates associated with vascular disease (VD) have been gradually increasing. Currently, the most common treatment for VD is surgery, with the progress in drug therapy remaining slow. Cannabidiol (CBD) is a natural extract of Cannabis sativa L. with sedative, analgesic, and nonaddictive properties. CBD binds to 56 cardiovascular-related receptors and exerts extensive regulatory effects on the cardiovascular system, making it a potential pharmacological agent for the management of VD. However, most CBD studies have focused on neurological and cardiac diseases, and research on the management of VD with CBD is still rare. In this review, we summarize the currently available data on CBD in the management of VD, addressing four aspects: the major molecular targets of CBD in VD management, pharmacokinetic properties, therapeutic effects of CBD on common VDs, and side effects. The findings indicate that CBD has anti-anxiety, anti-oxidation, and anti-inflammatory properties and can inhibit abnormal proliferation and apoptosis of vascular smooth muscle and endothelial cells; these effects suggest CBD as a therapeutic agent for atherosclerosis, stress-induced hypertension, diabetes-related vasculopathy, ischemia-reperfusion injury, and vascular damage caused by smoking and alcohol abuse. This study provides a theoretical basis for further research on CBD in the management of VD.

Background: Few methods can cocurrently mimic the pathological characteristics and nature history of human abdominal aortic aneurysms (AAAs), especially for the exist of the self -healing tendency of rodents. This study tested a novel method for the AAA rat model induced by retroperitoneal implantation of an osmotic pump system with lipopolysaccharide (LPS) based on the hypothesis that chronic inflammation of perivascular adipose tissue directly influenced the development and progression of AAAs. Methods: 20 male Sprague-Dawley rats (10 -month -old) fed with the Paigen diet were randomly divided into 4 groups: the blank group x2, the sham group x4, the empty capsule group x4, and the LPS capsule group x10. The LPS capsule group received implantations of the ALZET (R) osmotic pump capsule with LPS (3.6 mg/day) parallel to the abdominal aorta through a retroperitoneal approach. Two weeks later, 6 rats were randomly selected from the LPS capsule group to form the anti-inflammatory group and received implantations of another osmotic pump capsule with interleukin (IL) -10 (75 ng/day) through the same approach. The changes in abdominal aortic diameter were observed by ultrasound every 2 weeks, and samples were harvested for histopathologic and immunohistochemical analysis 6 weeks later. Results: Within the 6 weeks after modeling, the LPS capsule group showed sustained and significant aortic dilatation (P < 0.01), while the anti-inflammatory group showed a rapid and obvious shrinkage 2 weeks after the IL -10 osmotic pump capsule implantation (P < 0.01). The LPS capsule group presented excellent pathological mimicking of human AAAs and showed severe medial degeneration with the least elastic content among the 5 groups at the end of the sixth week (P < 0.05). Notably, the anti-inflammatory group showed perfect medial preservation with the most elastic content (P < 0.05) and the highest elastin/collagen ratio (P < 0.01) at the end of the study. Matrix metalloproteinases (MMP) 2 and 9 and toll -like receptor 2 showed strong expression in the LPS capsule group at the end of the sixth week, which was significantly higher than that in the blank group and sham group. Interestingly, the anti-inflammatory group showed a slightly higher MMP9 expression than the LPS capsule group though there was no statistical difference between them. Conclusions: This novel method for the rat AAA model induced by retroperitoneal implantation of an osmotic pump capsule with LPS can concurrently mimic the histological characteristics and natural history of human AAAs. Further studies were needed to improve the osmotic pump system.

Received: November 15, 2022. Revised: February 13, 2023. Accepted: February 18, 2023 © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction

Abstract Background: Thoracic endovascular aortic repair (TEVAR) is an important treatment for patients with acute complicated Stanford type B aortic dissection. However, postoperative distal aortic enlargement is a severe complication of TEVAR. This study aimed to construct a prediction model for postoperative distal aortic enlargement using machine learning algorithms and explore high-risk factors that accelerate the progression of postoperative distal aortic enlargement. Methods: Study participants were selected from the multicenter, open cohort ROBUST (Registry Of type B aortic dissection with the Utility of STent graft) study. The least absolute shrinkage and selection operator regression method was employed to select variables. Seven machine learning algorithms (k-nearest neighbor, logistic regression, decision tree, random forest, support vector machine, sklearn neural network, and extreme gradient boosting) were applied to construct prediction models. Further, to explore the important factors that affected the progression of postoperative distal aortic enlargement, we applied three different regression algorithms (random forest, extreme gradient boosting, and light gradient boosting machine) to analyze the data of patients with postoperative distal aortic enlargement. Results: We retrospectively analyzed the data of 184 patients who underwent thoracic endovascular aortic repair for type B aortic dissection at four medical centers. The median follow-up time was 12.37 months (IQR, 8.07–18.17 months). In total, 26 variables were identified using the least absolute shrinkage and selection operator regression. The model constructed using the random forest algorithm exhibited the best prediction performance among the seven models. The regression model constructed by the light gradient boosting machine showed better performance than the other two models. Accordingly, TAT_2.0 (partial thrombosis of the thoracic aorta), SVS (scored according to the comorbidity grading system of the Society for Vascular Surgery), and VRAOFL (visceral or renal aorta originating from a false lumen) were the top three high-risk factors that accelerated the progression of PDAE. Conclusions: The random forest prediction model can improve the prediction accuracy for postoperative distal aortic enlargement, and the light gradient boosting machine regression model can identify high-risk factors that accelerate the progression of postoperative distal aortic enlargement.

Background Clot analogs are essential in animal and in vitro experiments on mechanical thrombectomy devices for treating acute ischemic stroke. Clot analogs should be capable of reproducing a variety of arterial clots observed in clinical practice in terms of histological composition and mechanical properties. Methods Bovine blood with added thrombin was stirred in a beaker so that clots could be formed under the condition of dynamic vortical flow. Static clots were also prepared without stirring, and the properties of the static clots and dynamic clots were compared. Histological and scanning electron microscopy experiments were performed. Compression and relaxation tests were performed to evaluate the mechanical properties of the two types of clots. Thromboembolism and thrombectomy tests were conducted in an in vitro circulation model. Results Compared to the static clots, the dynamic clots prepared under vortical flow displayed a higher fibrin content, and their fibrin network was denser and sturdier than that of the static clots. The stiffness of the dynamic clots was significantly higher than that of the static clots. The stress of both types of clots could decay quickly under large sustained strain. The static clots could break at the bifurcation in the vascular model, while the dynamic clots could be firmly stuck in the vascular model. Conclusions Dynamic clots generated in dynamic vortical flow differ significantly from static clots in terms of their composition and mechanical properties, which may be beneficial information for preclinical research on mechanical thrombectomy devices.

Abstract Background Abdominal aortic aneurysms have a high mortality rate. While surgery is the preferred treatment method, the biological repair of abdominal aortic aneurysms is being increasingly studied. We performed cellular and animal experiments to investigate the simultaneous function and mechanism of fibroblast growth factor 18 and integrin β1 in the biological repair of abdominal aortic aneurysms. Methods Endothelial and smooth muscle cells of rat arteries were used for the cellular experiments. Intracellular integrin β1 expression was regulated through lentiviral transfection. Interventions with fibroblast growth factor 18 were determined according to the experimental protocol. Several methods were used to detect the expression of elastic fiber component proteins, cell proliferation, and migratory activity of endothelial and smooth muscle cells after different treatments. For animal experiments, abdominal aortic aneurysms were induced in rats by wrapping the abdominal aortae in sterile cotton balls soaked with CaCl2 solution. Fibroblast growth factor 18 was administered through tail vein injections. The local expression of integrin β1 was regulated through lentiviral injections into the adventitia of the abdominal aortic aneurysms. The abdominal aortae were harvested for pathological examinations and tensile mechanical tests. Results The expression of integrin β1 in endothelial and smooth muscle cells could be regulated effectively through lentiviral transfection. Animal and cellular experiments showed that fibroblast growth factor 18 + integrin β1 could improve the expression of elastic fiber component proteins and enhance the migratory and proliferative activities of smooth muscle and endothelial cells. Moreover, animal experiments showed that fibroblast growth factor 18 + integrin β1 could enhance the aortic integrity to withstand stretch of aortic aneurysm tissue. Conclusion Fibroblast growth factor 18 + integrin β1 improved the biological repair of abdominal aortic aneurysms in rats by increasing the expression of elastic proteins, improving the migratory and proliferative abilities of endothelial and smooth muscle cells, and improving aortic remodeling.

BACKGROUND:This study was performed to demonstrate the feasibility and effectiveness of a novel off-the-shelf endograft (G-Branch™; Lifetech Scientific, Shenzhen, China) for the treatment of patients with complex thoracoabdominal/abdominal aortic aneurysms.METHODS:Three patients (1 with a suprarenal abdominal aortic aneurysm and 2 with thoracoabdominal aortic aneurysms) were treated with the G-Branch endograft involving 2 proximal inner branches for the celiac axis and superior mesenteric artery and 2 distal side directional branches for the bilateral renal arteries.RESULTS:Technical success was achieved in all 3 patients, and no postoperative complications occurred. At 6-month follow-up, no adverse events occurred, and all the target vessels were patent.CONCLUSIONS:The newly developed G-Branch device allows the achievement of total endovascular revascularization of the visceral and renal arteries. Use of this device is feasible and effective. Long-term follow-up and a larger clinical trial are necessary to evaluate its reliability and durability.

Fenestrated/branched endovascular aneurysm repair is a feasible and effective treatment option for patients with postdissection thoracoabdominal/abdominal aneurysm. However, this technique is cumbersome when the target vessel originates from the false lumen. We herein report our primary experiences in utilizing a reversed off-the-shelf iliac branched device (IBD) stent to reconstruct the renal artery originating from the false lumen. This technique was performed in 3 patients (all men; 49, 46, and 45 years old) in our center. After deployment of the main aortic endograft, the distal re-entry in the common iliac artery was dilated by a balloon. The off-theshelf IBD was then reversely deployed to allow for deployment of the bridging stent graft. Finally, the IBD and the bridging stents were assembled and the IBD was connected to the main graft. No migration of the IBDs occurred, and all target vessels remained patent during follow-up. Utilization of a reversed off-the-shelf IBD for the renal artery originating from the false lumen is a feasible option, especially for patients with specific anatomical characteristics of postdissection aortic aneurysms.

Endovascular repair of an aortic arch aneurysm has made great progress in the last 10 years. Custom-made branched stent grafts have been used, and preliminary results have been promising. To reduce the effect of aortic arch anatomical variations on indications, we designed a new off-the-shelf modular double inner branch stent-graft system. This case is the "First-in-Man'' study for the device. A 74-year-old man presented with an asymptomatic saccular aneurysm and an ulcer lesion of the aortic arch. Left common carotid artery (LCCA) and left subclavian artery bypass was performed before endovascular repair. The modular stents reconstructed the innominate artery and LCCA. A follow-up on the computed tomography angiography 6-month results showed that the new device is safe and feasible for patients who are unfit for conventional surgery.

目的 探讨21例脾动脉瘤腔内治疗术后患者的围手术期护理要点.方法 回顾性分析我院血管外科2012年1月-2016年12月收治的21例脾动脉瘤腔内治疗后患者的护理资料,总结护理观察要点及相应的处理措施,出院后随访情况.结果 本组21例患者均手术成功,术后有4例患者疼痛症状缓解,2例患者主诉上腹部轻微疼痛,可耐受,未给予处理,出院时疼痛症状消失.通过护士的密切观察和护理,21例患者恢复顺利,住院期间无护理相关并发症发生.平均随访22个月(3-41个月),有2例患者经彩超检查存在小面积脾梗死,无临床症状,其余19例患者无相关并发症发生.结论 密切观察腹部症状及穿刺点情况,是脾动脉瘤围术期护理关键[1].

目的 探讨23例血栓闭塞性脉管炎患者行银杏叶提取物股动脉灌注治疗的护理观察要点.方法 回顾性分析我院血管外科2013年1月-2016年12月收治的23例血栓闭塞性脉管炎患者的护理资料,总结护理观察要点及相应的处理措施,出院后随访情况.结果 本组23例患者均手术成功,术后21例患者疼痛逐渐好转,其中有1例患者术后第三天主诉右足趾烧灼样疼痛,考虑为银杏叶提取物注射液药物刺激,遵医嘱给予停用后疼痛症状逐渐缓解.另1例患者术后第一天主诉患足剧痛,难以忍受,患足颜色苍白,足背动脉搏动减弱,及时报告医生,考虑血管内血栓形成,立即给予患者尿激酶20wu团注2次,患者疼痛症状随即改善,术后第二天患足皮肤颜色红润,搏动动脉可触及.有10例患者股动脉穿刺处有少量渗血,给予监测APTT,给予盐袋压迫止血,通过护士的密切观察和护理,23例患者恢复顺利,住院期间无护理相关并发症发生.随访3个月患者18例,随访6个月患者15例,随访期间无相关并发症发生.结论 银杏叶提取物股动脉灌注治疗期间,密切观察患足及穿刺点情况,及时评估疼痛性质,精心的护理是保证血栓闭塞性脉管炎患者预后的关键.

Several studies suggest that infrarenal aortic diameter is associated with lower-extremity peripheral artery disease (LE-PAD). However, data regarding the associations between infrarenal aortic diameter and LE-PAD are limited, especially in large sample populations and Asian or Chinese populations. Our analysis included 17279 Chinese hypertensive adults comprising 6590 men and 10689 women with a mean age of 64.74 ± 7.41 years. Participants were selected from 22693 candidates from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle–brachial index (ABI) at rest and typically an ABI ≤ 0.90 is used to define LE-PAD. The prevalence of LE-PAD was found to significantly decrease as the aortic diameter increased according to the tertile of the aortic diameter. LE-PAD was significantly more prevalent in the lowest tertile (OR = 1.58, 95% CI = 1.29–1.94, p < 0.001) and similarly prevalent in the highest tertile (OR = 0.92, 95% CI = 0.73–1.16, p = 0.49) when compared with the median tertile. No significant interactions between the aortic diameter and any of the stratified variables were found (all p > 0.05). In conclusion, Small aortic diameter (as opposed to large aortic diameter) is significantly associated with LE-PAD in Chinese hypertensive adults.

OBJECTIVE:To investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery (SCAT).METHODS:A retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years (range, 48-62 years). The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length (mean, 5.4 cm). The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually.RESULTS:The surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from (39.58 ± 9.54) mm Hg (1 mm Hg = 0.133 kPa) at pre-operation to (5.50 ± 2.39) mm Hg at immediate after operation (t = 15.492, P = 0.000). No recurrence or stenosis was found at 9 months to 3 years of follow-up. The systolic and diastolic pressures at last follow-up were significantly improved to (132.17 ± 6.24) mm Hg and (82.67 ± 6.51) mm Hg from (152.83 ± 14.80) mm Hg and (94.17 ± 11.30) mm Hg at pre-operation (t = 5.751, P = 0.000; t = 4.976, P = 0.000).CONCLUSION:Vascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.

OBJECTIVE:To compare the perioperative outcome between the endovascular repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm.METHODS:From January 2006 to January 2013, totally 66 patients with ruptured abdominal aortic aneurysm (rAAA) treated by surgery were retrospectively analyzed in Department of vascular surgery, People's Liberation Army General Hospital. According to the repair method, all the subjects were divided into EVAR group and OSR group. EVAR group included 40 patients, 30 patients were male, 10 patients were female, aged from 47 to 78 with a mean of (71 ± 7) years. OSR group included 26 patients, 21 patients were male, aged from 45 to 87 with a mean of (72 ± 9) years. The difference of the operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate and the difference of the two intervention rate were compared between the 2 groups by χ(2) test and t test.RESULTS:There were significant differences between the 2 groups in operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate ((183 ± 44) minutes vs. (384 ± 108) minutes, t = -10.59, P = 0.00; (0.4 ± 0.8) units vs. (1.1 ± 1.8) units, t = -2.19, P = 0.03; (3.0 ± 1.8) d vs. (8.5 ± 5.1) d, t = -6.34, P = 0.00; 20.0% (8/40) vs. 46.2% (12/26), χ(2) = 5.10, P = 0.02; 25.0% (10/40) vs. 53.8% (14/26), χ(2) = 5.67, P = 0.02). There were no significant differences in frozen plasma quantities and the two intervention rate between the 2 groups (t = -1.98, P = 0.05; χ(2) = 0.49, P = 0.48).CONCLUSIONS:EVAR decreases the perioperative mortality and adverse event of rAAA compared with OSR. More studies are necessary to compare the middle and long-outcome between EVAR and OSR of rAAA.

Background: To evaluate the safety and efficacy of chimney endovascular abdominal aortic repair (Ch-EVAR) for juxtarenal abdominal aortic aneurysm.Methods: Electronic literature published between 2003 and 2014 were searched from MEDLINE and EMBASE online databases. Inclusion criteria for articles included that more than 3 patients were enrolled, chimney graft techniques were used, and the basic outcomes, such as indications, mortality within 30-day or during follow-up, complications, endoleaks, and branch vessel patency were collected. The data were pooled for analysis. Meta-analysis was performed using Stata version 11 and heterogeneity was estimated using Cochrane Q statistic and I 2 statistic.Results: In total, 12 electronic literature met the inclusion criteria and 236 patients (mean age, 73.9 years) undergone Ch-EVAR were collected. A total of 335 chimney grafts were implanted, including 288 to the renal arteries and 47 to superior mesenteric arteries. Mortality (< 30 days) and mortality (during follow-up; a mean of 12 months) were 3.8% (9/236) and 10.6% (25/236), respectively. The rate of type I, II and III endoleaks during follow-up was 11.8% (28/236), 8.1% (19/236), and 0.4% (1/236), respectively. The chimney graft patency at 6 month was 96.6%. Meta-analysis showed that the rates of endoleaks (during follow-up), mortality (< 30 days) and mortality (during follow-up) were 18%, 7% and 13%, respectively.Conclusions: Chimney graft is an efficient therapy with high initial technical success rate and favorable rates for perioperative outcomes.

OBJECTIVE:To review the progress of the robotic applications in vascular surgery.METHODS:Recent literature about the robotic applications in vascular surgery was reviewed and analyzed.RESULTS:Robotic system is composed of surgery robotic system and endovascular interventional robotic system. The time of aortic clamping and anastomosis is reduced considerably during the robotic-assisted aorta bypass surgery, and the dissection of aorta is completed successfully in totally robotic approach. Endovascular interventional robotic system has good performance in navigation and stability, and shows apparent advantages in passing special anatomical segment and complicated lesion. However, the robotic systems are still limited in application for high cost. The problem of tactile feedback should also be solved quickly.CONCLUSION:Robotic systems have apparent advantages and good prospect in vascular surgery. Nevertheless, it still require many clinical trials to formulate the indication and contraindication, to establish standard procedure, to assess the long-term effectiveness of the robotic systems and so on.

OBJECTIVETo compare the advantages and disadvantages between double Perclose ProGlide crossing suture and traditional suture for the closure of 20F or 22F access points so as to provide a basis for selecting appropriate approach to repair the puncture points in endovascular aortic repair.METHODSBetween June 2007 and May 2011, 103 patients (115 common femoral arteries) underwent endovascular aortic repair using sheaths of 20F or 22F (outer diameter); double Perclose ProGlide crossing suture was performed for closure of puncture sites in 57 cases (64 common femoral arteries) (double Perclose group) and traditional suture in 46 cases (51 common femoral arteries) (traditional group). There was no significant difference in age, gender, or disease duration between 2 groups (P > 0.05).RESULTSThe operation time, blood loss, and hospitalization days of double Perclose group were significantly better than those of traditional group (P < 0.05). Ecchymoma in inguinal region and lymphatic leakage occurred in 5 cases (5 common femoral arteries) and 2 cases (2 common femoral arteries) of double Perclose group respectively, in 2 cases (2 common femoral arteries) and 6 cases (8 common femoral arteries) of traditional group respectively; no significant difference was found in the rate of the early complication between double Perclose group and traditional group (7.8% vs. 15.7%, chi2 = 1.76, P = 0.19). The technique success rate of double Perclose group was 96.9% (62/64), and was 100% (51/51) in traditional group, showing no significant difference (chi2 = 0.31, P = 0.50). All patients were followed up, 2-19 months (mean, 15 months) in double Perclose group and 2-18 months (mean, 14 months) in traditional group. Pseudoaneurysm occurred in the puncture region at 3 months in 1 case (1 common femoral artery) of double Perclose group, and incision and suture therapy was performed; no arteriostenosis or pseudoaneurysm occurred in other cases; and the rate of mid-term complication was 1.6% (1/64) in double Perclose group and was 0 in traditional group, showing no significant difference (P = 1.000).CONCLUSIONDouble Perclose ProGlide crossing suture has the same effectiveness to traditional surture in repairing the puncture point with 20F or 22F, but it is superior to traditional suture in reducing operation time, blood loss, and hospitalization days.