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The use of vascular closure devices outside the catheterization laboratory after neurointerventional procedures is
Rakesh Khatri1, Nassir Rostambeigi, Ameer E Hassan
1Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Insights
Deploying vascular closure devices (VCDs) outside the catheterization lab is safe and feasible. This approach does not increase major vascular complications, offering an alternative for femoral artery hemostasis.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Neurointerventional Radiology
Background:
- Vascular closure devices (VCDs) are crucial for achieving hemostasis after arterial access.
- Deployment of VCDs typically occurs within the catheterization laboratory.
- Limited data exists on the safety and feasibility of VCD deployment outside this controlled environment.
Purpose of the Study:
- To evaluate the safety and feasibility of deploying vascular closure devices (VCDs) outside the traditional catheterization laboratory setting.
- To compare the rates of major vascular complications between VCD deployments performed inside versus outside the catheterization laboratory.
Main Methods:
- Retrospective review of 918 VCD deployments in 799 patients undergoing neurointerventional procedures over two years.
- Comparison of major vascular complication rates (defined by Society of Interventional Radiology criteria) for VCDs deployed inside and outside the catheterization laboratory.
- Analysis of complication rates across different procedure types and VCD models.
Main Results:
- 11.2% of VCD deployments (103/918) occurred outside the catheterization laboratory, with no significant differences in patient demographics or device types.
- Overall major vascular complication rate was 1.1% (10/918), including dissection, hematoma, pseudoaneurysm, and ischemia.
- The rate of major vascular complications was similar for VCDs deployed inside (1.0%) versus outside (1.9%) the catheterization laboratory (p=0.3).
Conclusions:
- Vascular closure device deployment outside the catheterization laboratory is a safe and feasible alternative.
- This practice does not elevate the risk of major vascular complications.
- It presents a viable option for femoral artery hemostasis when timely VCD deployment is necessary but cannot be performed in the catheterization lab.
Purpose:
To investigate the feasibility and safety of vascular closure device (VCD) deployment outside the catheterization laboratory.
Methods:
Medical records were reviewed of all 799 patients (396 men; mean age 56 ± 16 years) who underwent deployment of 918 VCDs following diagnostic or therapeutic neurointerventional procedures over a 2-year period at 2 comprehensive stroke centers. The rates of major vascular complications in patients undergoing VCD deployment in and outside the catheterization laboratory were compared. Major vascular complications were adjudicated using definitions by the Society of Interventional Radiology; comparisons were made between different procedure types and closure devices.
Results:
During the observation period, 103 (11.2%) of 918 VCD deployments were performed outside the catheterization laboratory. Age, gender, procedure type, and device types were not different between the groups. A total of 10 (1.1%) major vascular complications occurred, including dissection requiring angioplasty (n = 1), hematoma requiring blood transfusion (n = 4), pseudoaneurysm requiring thrombin injection (n = 2), and lower limb ischemia necessitating surgical removal of the VCD (n = 3). Rates of major vascular complications were not significantly different between VCDs deployed inside the catheterization laboratory [1.0% (8/815)] compared to outside [1.9% (2/103), p = 0.3].
Conclusion:
VCD deployment outside the catheterization laboratory does not increase the rate of major vascular complications and may be an alternative approach for femoral artery hemostasis when VCD deployment needs to be deferred.
