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Vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus
G Dangas1, R Mehran, S Kokolis
1Cardiovascular Research Foundation, Lenox Hill Heart & Vascular Institute, New York, New York, USA.
Insights
Arteriotomy closure devices (ACD) show higher vascular complication rates, including hematoma and the need for surgical repair, compared to manual compression after percutaneous coronary interventions (PCI). Further research is needed to improve ACD safety.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Arteriotomy closure devices (ACD) offer hemostasis and early ambulation post-percutaneous coronary intervention (PCI).
- Safety of ACD compared to manual compression in a large patient cohort requires thorough investigation.
Purpose of the Study:
- To evaluate and compare vascular complication rates between arteriotomy closure devices (ACD) and manual compression for hemostasis after percutaneous coronary interventions (PCI).
Main Methods:
- A cohort of 5,093 patients undergoing transfemoral PCI were analyzed.
- Univariate and multivariate analyses identified predictors of vascular complications in groups using ACD (n=516) versus manual compression (n=5,892) for post-sheath removal hemostasis.
Main Results:
- Arteriotomy closure devices (ACD) were linked to increased hematoma (9.3% vs 5.1%) and significant hematocrit drop (5.2% vs 2.5%) compared to manual compression.
- Rates of pseudoaneurysm and arteriovenous fistulae were similar; however, vascular surgical repair was more frequent with ACD (2.5% vs 1.5%).
Conclusions:
- Early experience indicates arteriotomy closure devices (ACD) are associated with higher vascular complication rates post-PCI than manual compression.
- Findings suggest a need for caution and potential improvements in ACD technology or application.
Objectives:
We evaluated the vascular complications after hemostasis with arteriotomy closure devices (ACD) versus manual compression after percutaneous coronary interventions (PCI).
Background:
Previous clinical studies have indicated that ACD can be used for achievement of hemostasis and early ambulation after PCI. This study investigated the safety of ACD in achieving hemostasis after PCI compared with manual compression in a large cohort of consecutive patients.
Methods:
A total of 5,093 patients were followed after PCI was performed with the transfemoral approach. Univariate and multivariate analysis were used to identify the predictors of vascular complications with ACD (n = 516) or with manual compression (n = 5,892) as a hemostasis option after sheath removal.
Results:
The use of ACD was associated with a more frequent occurrence of hematoma compared with manual compression (9.3 vs. 5.1%, p < 0.001). There was also a higher rate of significant hematocrit drop (>15%) with ACD versus manual compression (5.2% vs. 2.5%, p < 0.001). Similar rates of pseudoaneurysm and arteriovenous fistulae were noted with either hemostasis technique. Vascular surgical repair at the access site was required more often with ACD versus manual compression (2.5 vs. 1.5%, p = 0.03).
Conclusions:
In this early experience with ACD after PCI, their use was associated with higher vascular complication rates than hemostasis with manual compression.