Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and...

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Procedures

Background:

• Manual compression (MC) and vascular closure devices (VCDs) are used for hemostasis after cardiac interventions.
• Controversy exists regarding the optimal method, with a need for systematic analysis.

Purpose of the Study:

• To systematically compare the efficacy, safety, and patient satisfaction of VCDs versus MC for vascular access site hemostasis.
• To provide a comprehensive meta-analysis to resolve controversies in the field.

Main Methods:

• Systematic search of PubMed, EMbase, Cochrane Library, and Web of Science for comparative studies up to April 2022.
• Meta-analysis of 32 studies (33,481 patients) assessing hemostasis time, ambulation, discharge, complication rates, and patient satisfaction.
• Heterogeneity and publication bias were evaluated using standard statistical methods.

Main Results:

• VCDs significantly shortened time to hemostasis, ambulation, and discharge (p < 0.00001).
• VCDs were associated with higher patient satisfaction (p = 0.002) and potentially lower major complication risk (p = 0.0001), though this was not supported by RCTs alone (p = 0.68).
• No significant differences were found in total or bleeding-related complication rates between VCDs and MC.

Conclusions:

• Vascular closure devices offer significant advantages over manual compression, including faster hemostasis, earlier ambulation, and discharge.
• VCDs enhance patient satisfaction and may lead to cost savings without increasing vascular complication risks.
• The findings support the broader adoption of VCDs in cardiac interventional procedures.