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Immediate ambulation following diagnostic coronary angiography procedures utilizing a vascular closure device (The
Christopher H Crocker1, Kevin T Cragun, Farris K Timimi
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Insights
The Closer device safely and effectively enables immediate ambulation after diagnostic coronary angiography for most patients, achieving 96% hemostasis and allowing 89% to walk immediately.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Devices
Background:
- Diagnostic coronary angiography requires vascular access closure.
- Traditional methods may involve prolonged bed rest, delaying patient ambulation.
- Suture-mediated closure devices offer a potential alternative for faster recovery.
Purpose of the Study:
- To evaluate the safety and efficacy of The Closer, a suture-mediated vascular closure device.
- To assess the feasibility of immediate patient ambulation following its use.
- To determine the rate of complications associated with The Closer in this setting.
Main Methods:
- Retrospective analysis of 487 patients undergoing diagnostic coronary angiography.
- Utilized The Closer device for vascular closure.
- Implemented an immediate ambulation protocol, with some patients assigned intermediate bed rest.
- Monitored for hemostasis, bleeding, and access site complications.
Main Results:
- 89% of patients achieved immediate ambulation (mean 6.3 minutes).
- 7% experienced intermediate bed rest (mean 105.2 minutes) due to minor bleeding or physician preference.
- Overall hemostasis was achieved in 96% of patients.
- A low rate of complications was observed, with 0.8% experiencing recurrent bleeding and no major adverse events like hematoma, fistula, or infection.
Conclusions:
- The Closer is a safe and effective device for vascular closure after diagnostic coronary angiography.
- It facilitates rapid patient ambulation, improving patient experience and potentially reducing healthcare costs.
- The device demonstrates a favorable safety profile with minimal complications.
Objective:
We investigated the safety and efficacy of The Closer, a suture-mediated vascular closure device, to facilitate immediate ambulation after diagnostic coronary angiography.
Methods And Results:
We identified 487 non-consecutive patients who were eligible for an immediate ambulation protocol following vascular closure after diagnostic coronary angiography. A total of 434 patients (89%) were allowed immediate ambulation (mean time, 6.3 +/- 2.4 minutes) and 34 patients (7%) were treated with intermediate duration bed rest (mean time, 105.2 +/- 55.3 minutes). Of the 34 patients treated with intermediate duration bed rest, ten had minor bleeding from the arterial access tract requiring 2 5 minutes of light compression and 24 were delayed secondary to physician preference. Nineteen patients (4%) failed to achieve hemostasis with The Closer. Outpatients were followed up at 24 hours, and inpatients were followed up the next morning. Four patients (0.8%) suffered recurrent femoral artery bleeds after initially successful vascular closure. Three recurrent bleeds occurred during the observation period in-hospital and one occurred 6 days after device deployment. At follow-up, no patients developed the following: hematoma > 4 cm, ipsilateral retroperitoneal bleed, arterio-venous fistula, pseudoaneurysm, access site infection or loss of distal pulses. No patients had lower extremity ischemia or required blood transfusion.
Conclusion:
Use of The Closer after diagnostic angiography with subsequent immediate ambulation is safe and effective for most patients. Overall, hemostasis was achieved in 96% of patients, with 89% of our patients able to ambulate immediately and 7% able to ambulate after intermediate duration bed rest.