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Network meta-analysis of studies comparing closure devices for femoral access after percutaneous coronary

Mario Iannaccone1, Gaëlle Saint-Hilary2, Davide Menardi2

  • 1SS. Annunziata Hospital, Savigliano, ASL CN1.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|July 26, 2018
PubMed

Insights

Vascular closure devices do not reduce complications compared to manual compression after femoral procedures. However, devices like Angioseal significantly shorten hemostasis time, with StarClose showing the best complication profile.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Devices

Background:

  • Femoral vascular access is common after coronary angiography and percutaneous coronary intervention.
  • Evidence comparing the efficacy and safety of various vascular closure devices (VCDs) against manual compression is limited.
  • Comparative data across different sheath diameters, patient age, and sex is particularly lacking.

Purpose of the Study:

  • To conduct a network meta-analysis comparing the efficacy and safety of different VCDs versus manual compression for femoral artery access closure.
  • To evaluate complication rates and time to hemostasis across various VCDs.
  • To assess the influence of sheath diameter, patient age, and sex on VCD performance.

Main Methods:

  • A systematic review and network meta-analysis of 30 studies involving 5620 patients undergoing femoral procedures.
  • Manual compression served as the control group in all included studies.
  • Comparison of multiple VCDs including Angioseal, Exoseal, Perclose, Vasoseal, DUETT, StarClose, and Techstar.

Main Results:

  • No VCD demonstrated superiority over manual compression in reducing overall vascular complications.
  • Metaregression analysis confirmed these findings were consistent across varying sheath diameters, patient age, and sex.
  • Several VCDs, including Angioseal, Vasoseal, Perclose, Femoseal, and Techstar, significantly reduced time to hemostasis compared to manual compression.

Conclusions:

  • Vascular closure devices do not offer a significant advantage over manual compression in preventing complications.
  • VCDs, particularly Angioseal, provide a notable benefit by reducing the time required for hemostasis.
  • StarClose emerged as the device with the highest probability of being the best in terms of complication rates.
Abstract

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