The StarClose vascular closure device in antegrade and retrograde punctures: a single-center experience

To evaluate the StarClose device and compare its success rates in antegrade and retrograde puncture closures.

A retrospective review of all StarClose deployments from April 2005 to July 2007 was performed in a single tertiary referral institution radiology department. In this time period, 143 StarClose devices were deployed in 132 patients (102 men; mean age 68+/-14 years). Of these, 40 (28%) were deployed after antegrade and 103 (72%) after retrograde common femoral arterial punctures. Hospital notes were reviewed to evaluate minor (managed conservatively with compression) and major (requiring surgical intervention) complication rates in the immediate postprocedure period and the following 24 hours. Late complications were also assessed.

There were 11 (7.7%) immediate failures of device deployment: 4/40 (10.0%) antegrade and 7/103 (6.8%) retrograde. Within these 11 punctures, 1 major complication occurred that required surgical retrieval of the device following a retrograde puncture. No other major and 12 (9.1%) minor complications occurred following the 132 successful StarClose deployments. No late complications were seen on clinical or radiological follow-up. The total major complication rate was 0.7% (1/143). The total minor complication rate was 15.4% (22/143): 9/40 (22.5%) following antegrade punctures and 13/103 (12.6%) following retrograde punctures.

The StarClose device is associated with a low major complication rate. A higher rate of minor complications was observed following antegrade punctures but all were managed with simple compression. Prospective randomized trials comparing closure devices are needed to evaluate their relative efficacy and safety in antegrade and retrograde punctures.