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Femoral Artery Closure Devices vs Manual Compression During Cardiac Catheterization and Percutaneous Coronary
Rolf P Kreutz1,2, Sujoy Phookan1,2, Hamid Bahrami1,2
1Division of Cardiovascular Medicine, Indiana University School of Medicine/Indiana University Health Methodist, Indianapolis, Indiana.
Insights
Vascular closure devices significantly reduce complications and bleeding after percutaneous coronary intervention (PCI) compared to manual compression. For diagnostic catheterization alone, no significant difference in access-site complications was observed.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Femoral arterial access is common for cardiac catheterization and PCI, despite rising radial access use.
- Vascular closure devices aim to reduce closure times, but clinical trial data on complication rates vary.
- Contemporary outcomes with common femoral artery closure devices require examination.
Purpose of the Study:
- To compare outcomes of diagnostic catheterization and PCI using different femoral artery closure methods.
- To assess vascular access complications and bleeding events associated with various closure devices versus manual compression.
Main Methods:
- Retrospective analysis of 14,401 diagnostic catheterizations and 11,712 PCIs using femoral artery access.
- Comparison of outcomes based on closure type: manual compression, Angio-Seal, Perclose, or Mynx.
- Measurement of access complications and bleeding using National Cardiovascular Data Registry definitions.
Main Results:
- Vascular closure devices significantly reduced vascular access complications and bleeding events in PCI patients compared to manual compression.
- No significant difference in access-site complications was found for diagnostic catheterization alone.
- Perclose and Angio-Seal devices showed lower hematoma rates than Mynx.
Conclusions:
- Femoral artery closure devices reduce vascular access complication rates compared to manual compression in PCI patients.
- The findings support the use of closure devices to improve safety in PCI procedures.
Background:
Femoral arterial access remains widely used despite recent increase in radial access for cardiac catheterization and percutaneous coronary intervention (PCI). Various femoral artery closure devices have been developed and are commonly used to shorten vascular closure times, with variable rates of vascular complications observed in clinical trials. We sought to examine the rates of contemporary outcomes during diagnostic catheterization and PCI with the most common femoral artery closure devices.
Methods:
We identified patients who had undergone either diagnostic catheterization alone (n = 14,401) or PCI (n = 11,712) through femoral artery access in the Indiana University Health Multicenter Cardiac Cath registry. We compared outcomes according to closure type: manual compression, Angio-Seal, Perclose, or Mynx. Access complications and bleeding outcomes were measured according to National Cardiovascular Data Registry standard definitions.
Results:
The use of any vascular closure device as compared to manual femoral arterial access hold was associated with a significant reduction in vascular access complications and bleeding events in patients who underwent PCI. No significant difference in access-site complications was observed for diagnostic catheterization alone. Among closure devices, Perclose and Angio-Seal had a lower rate of hematoma than Mynx.
Conclusions:
The use of femoral artery access closure devices is associated with a reduction in vascular access complication rates as compared to manual femoral artery compression in patients who undergo PCI.
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