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Comparison of arterial closure devices in antegrade and retrograde punctures
Albert Ho Yuen Chiu1, Ross Vander Wal, Kenneth Tee
1Department of Radiology, Sir Charles Gairdner Hospital, Perth, Australia. albert.h.chiu@gmail.com
Insights
Angio-Seal demonstrated a lower primary failure rate compared to Perclose for antegrade common femoral artery punctures. Further research is recommended to validate these findings for closure devices in antegrade punctures.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Vascular closure devices are crucial for hemostasis after peripheral angioplasty.
- Common femoral artery (CFA) punctures can be performed using antegrade or retrograde approaches.
- Comparing the efficacy and safety of different closure devices is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy, primary failure rates, and complications of Angio-Seal and Perclose devices.
- To evaluate device performance in both antegrade and retrograde common femoral artery (CFA) punctures.
- To identify potential differences in outcomes based on puncture direction and device type.
Main Methods:
- Retrospective single-center analysis of 123 CFA punctures in 97 patients undergoing peripheral angioplasty.
- Patients were categorized by puncture direction (antegrade or retrograde) and closure device (Angio-Seal or Perclose).
- Outcomes assessed included primary endpoint achievement, primary failure rates, and postprocedural complications.
Main Results:
- No significant difference in the primary endpoint (complication-free progress to discharge) between devices or puncture directions.
- Angio-Seal showed a significantly lower primary failure rate than Perclose in antegrade punctures (11.1% vs. 38.7%, p=0.038).
- Antegrade punctures had a higher overall primary failure rate, but this did not lead to increased postprocedural complications.
Conclusions:
- Angio-Seal is associated with a lower primary failure rate than Perclose for antegrade CFA punctures.
- The study highlights the need for larger investigations to compare closure device efficacy specifically in antegrade punctures.
- Current findings suggest potential device-specific advantages depending on puncture approach.
Purpose:
To compare the efficacy, primary failure rates, and complications for the Angio-Seal and Perclose closure devices in antegrade and retrograde common femoral artery (CFA) punctures during peripheral angioplasty procedures.
Methods:
A retrospective single-center analysis was conducted between April 2002 and June 2006 of all patients who had a CFA puncture and no other intervention planned during the same admission. Patients undergoing thrombolysis were excluded. Of 215 punctures in 191 patients, 123 closures in 97 patients (82 men; mean age 69.5 +/-10.4 years, range 41-93) were eligible for analysis. Of these, 49 punctures were antegrade and 74 were retrograde. An Angio-Seal device was used in 40 closures, while 83 punctures were closed with a Perclose device. Deployment outcomes and complications were compared between devices for each puncture direction and between antegrade and retrograde punctures.
Results:
Seventy-eight (63.4%) of the 123 closures reached the primary endpoint of complication-free progress to discharge, comprising 30 (61.2%) of the 49 antegrade closures and 48 (64.9%) of the 74 retrograde closures. There was no significant difference between the devices for the primary endpoint. Twenty-two (17.9%) attempted closures failed. Forty-one (33.3%) closures had a complication after the procedure, but none required further intervention. In antegrade closures, Angio-Seal had a significantly lower rate of primary failure (11.1% versus 38.7% for Perclose, p = 0.038). Antegrade closures had a higher rate of primary failure (p<0.01); however, this did not translate into any significant differences in postprocedural complications. No significant differences in primary failure or complication rates were found between the devices when used in retrograde punctures.
Conclusion:
Angio-Seal had a lower rate of primary failure than Perclose in antegrade puncture closures. We believe this reinforces the need for larger studies to compare closure devices in antegrade punctures.
