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Vascular closure device failure: frequency and implications: a propensity-matched analysis.

Sripal Bangalore1, Nipun Arora, Frederic S Resnic

  • 1Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.

Circulation. Cardiovascular Interventions
|December 25, 2009
PubMed
Summary

Vascular closure device (VCD) failure is rare, occurring in 2.7% of cases. However, VCD failure significantly increases the risk of vascular complications, necessitating close patient monitoring.

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Medical Devices

Background:

  • Vascular closure devices (VCDs) are widely used after cardiac catheterization to improve patient outcomes.
  • The frequency and consequences of VCD failure remain incompletely understood.

Purpose of the Study:

  • To define the incidence and clinical sequelae of VCD failure in a large patient cohort.
  • To assess the association between VCD failure and vascular complications.

Main Methods:

  • A prospective registry of 9823 patients undergoing cardiac catheterization using collagen plug-based (Angio-Seal) or suture-based (Perclose) VCDs was analyzed.
  • VCD failure was defined as unsuccessful deployment or failure to achieve hemostasis.
  • Vascular complications were categorized as major, minor, or any, and compared between successful and failed VCD deployments.

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Main Results:

  • VCD failure occurred in 2.7% of patients (268/9823), with a higher incidence in percutaneous coronary intervention (3.0%) versus diagnostic procedures (2.3%).
  • Patients experiencing VCD failure had a significantly increased risk of any vascular complication (6.7% vs. 1.4%), major complication (1.9% vs. 0.6%), and minor complication (6.0% vs. 1.1%).
  • This increased risk of vascular complications associated with VCD failure persisted even after propensity score matching.

Conclusions:

  • Vascular closure device failure is an infrequent event in current clinical practice.
  • Despite its rarity, VCD failure is strongly associated with a substantial rise in the risk of vascular complications.
  • Close monitoring of patients experiencing VCD failure is crucial to manage potential complications effectively.