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Practices and complications of vascular closure devices and manual compression in patients undergoing elective

Nathaniel R Smilowitz1, Ajay J Kirtane, Michael Guiry

  • 1Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.

The American Journal of Cardiology
|April 10, 2012
PubMed

Insights

Vascular closure devices (VCDs) show superior results compared to manual compression for hemostasis after coronary angiography and PCI. VCDs significantly reduce access complications, improving patient outcomes in these common cardiac procedures.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Femoral arterial puncture is standard for coronary angiography and PCI.
  • Access complications, though infrequent, increase morbidity and healthcare costs.
  • Optimal hemostasis strategy remains debated, with no consensus on Vascular Closure Devices (VCDs) versus manual compression (MC).

Purpose of the Study:

  • To compare the efficacy and safety of VCDs versus MC for hemostasis after elective transfemoral coronary procedures.
  • To identify predictors of vascular access complications in patients undergoing coronary angiography and PCI.

Main Methods:

  • Retrospective review and nested case-control study of 9,108 consecutive patients over 3 years.
  • Analysis of vascular complications including bleeding, pseudoaneurysm, and infection.
  • Comparison of outcomes between MC (28.3%) and VCD (71.7%) hemostasis strategies.

Main Results:

  • Overall complication rate was low at 0.81%.
  • VCD use was associated with significantly fewer complications (0.64%) compared to MC (1.24%, p=0.004).
  • Older age and large femoral sheath use (7Fr-8Fr) were independent predictors of complications.

Conclusions:

  • Vascular closure devices are associated with superior outcomes and fewer complications than manual compression for transfemoral coronary procedures.
  • Careful selection of hemostasis strategy and closure device can further minimize complication rates.
  • VCD use is a predictor of fewer vascular access complications.

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