title: Vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus arteriotomy closure devices.
abstract: OBJECTIVE
  We evaluated the vascular complications after hemostasis with arteriotomy closure devices (ACD) versus manual compression after percutaneous coronary interventions (PCI).
  
  
  BACKGROUND
  Previous clinical studies have indicated that ACD can be used for achievement of hemostasis and early ambulation after PCI. This study investigated the safety of ACD in achieving hemostasis after PCI compared with manual compression in a large cohort of consecutive patients.
  
  
  METHODS
  A total of 5,093 patients were followed after PCI was performed with the transfemoral approach. Univariate and multivariate analysis were used to identify the predictors of vascular complications with ACD (n = 516) or with manual compression (n = 5,892) as a hemostasis option after sheath removal.
  
  
  RESULTS
  The use of ACD was associated with a more frequent occurrence of hematoma compared with manual compression (9.3 vs. 5.1%, p < 0.001). There was also a higher rate of significant hematocrit drop (>15%) with ACD versus manual compression (5.2% vs. 2.5%, p < 0.001). Similar rates of pseudoaneurysm and arteriovenous fistulae were noted with either hemostasis technique. Vascular surgical repair at the access site was required more often with ACD versus manual compression (2.5 vs. 1.5%, p = 0.03).
  
  
  CONCLUSIONS
  In this early experience with ACD after PCI, their use was associated with higher vascular complication rates than hemostasis with manual compression.
authors.affiliation: Cardiovascular Research Foundation, Lenox Hill Heart & Vascular Institute, New York, New York, USA.
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: S
authors.initials: S
authors.lastname: Kokolis
authors.forename: D
authors.initials: D
authors.lastname: Feldman
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: A J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: G W
authors.initials: GW
authors.lastname: Stone
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary; D001164:Arteriovenous Fistula / Q000209:etiology; D005260:Female; D005263:Femoral Artery; D006400:Hematocrit; D006406:Hematoma / Q000209:etiology; D006489:Hemostatic Techniques / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011677:Punctures / Q000009:adverse effects*; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000209:etiology*