title: The safety and efficacy of the StarClose Vascular Closure System: the ultrasound substudy of the CLIP study.
abstract: BACKGROUND
  The StarClose Vascular Closure System (Abbott Vascular, Redwood City, CA) features a nitinol clip that is designed to achieve closure of the femoral arteriotomy access site. The CLIP Study was performed to assess the safety and efficacy of StarClose when compared with standard manual compression following 5-6 French diagnostic or interventional percutaneous procedures. A substudy of this trial was designed to assess the utility of duplex ultrasonography to assess patency of the femoral artery and to determine access site complications (pseudoaneurysm, arteriovenous fistula, hematoma, deep vein thrombosis) in a multicenter prospective trial. This is the report of the duplex ultrasound (DUS) substudy of the CLIP trial.
  
  
  METHODS
  A total of 17 U.S. sites enrolled 596 subjects with 483 subjects randomized at a 2:1 ratio to receive StarClose or manual compression of the arteriotomy after a percutaneous procedure. The study included roll-in (n = 113), diagnostic (n = 208), and interventional (n = 275) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis. A substudy of the CLIP interventional arm evaluated DUS images of the closure site at five study sites, targeting 100 subjects at day 30 following hemostasis. The DUS protocol was devised and implemented by an independent vascular ultrasound core laboratory with extensive experience in vascular device trials. DUS inguinal region from 6 cm proximal to 6 cm distal to the arteriotomy puncture was performed. A qualitative examination was performed to determine the presence of iatrogenic vascular injuries: hematoma, pseudoaneurysm (PSA), arteriovenous fistula (AVF), and arterial/venous thrombosis or stenosis using 2-dimensional gray scale, color, and focused Doppler images.
  
  
  RESULTS
  DUS of 96 subjects randomized to StarClose (n = 71) and compression (n = 25) were performed and evaluated. There was no evidence of hematoma, PSA, or AVF observed in the StarClose group. No StarClose subjects in the substudy had a PSA or AVF. All patients in the substudy demonstrated patency of the access site artery and vein without thrombosis or stenosis. Finally, in the entire study cohort, no clinically-driven DUS studies demonstrated iatrogenic vascular injury or vessel thrombosis in the StarClose treated patients.
  
  
  CONCLUSIONS
  DUS, a safe and reliable method for determining the safety and efficacy of access site closure devices, is a reliable, safe, inexpensive and accurate method of assessing vascular access site complications in multicenter trials. In this substudy of the CLIP study, DUS found no statistical difference in access site complications between the StarClose and manual compression groups. Both groups maintained vessel patency without stenosis, thrombosis, hematoma, pseudoaneurysm, or AV fistula.
authors.affiliation: VasCore, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. mjaff@partners.org
authors.forename: M R
authors.initials: MR
authors.lastname: Jaff
authors.forename: G
authors.initials: G
authors.lastname: Hadley
authors.forename: J B
authors.initials: JB
authors.lastname: Hermiller
authors.forename: C
authors.initials: C
authors.lastname: Simonton
authors.forename: T
authors.initials: T
authors.lastname: Hinohara
authors.forename: L
authors.initials: L
authors.lastname: Cannon
authors.forename: M
authors.initials: M
authors.lastname: Reisman
authors.forename: G
authors.initials: G
authors.lastname: Braden
authors.forename: D R
authors.initials: DR
authors.lastname: Fletcher
authors.forename: M
authors.initials: M
authors.lastname: Zapien
authors.forename: T M
authors.initials: TM
authors.lastname: Chou
authors.forename: K
authors.initials: K
authors.lastname: DiDonato
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology; D006328:Cardiac Catheterization / Q000295:instrumentation*; D003097:Collateral Circulation; D004867:Equipment Design / Q000295:instrumentation; D004869:Equipment Safety / Q000295:instrumentation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology; D006487:Hemostasis; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery; D013525:Surgical Instruments / Q000009:adverse effects; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D000497:Alloys; C013616:nitinol