VIPER-2: a prospective, randomized single-center comparison of 2 different closure devices with a hemostatic wound dressing for closure of femoral artery access sites.
OBJECTIVE
To report the outcome of a prospective randomized safety and performance trial of 2 access site closure devices versus a wound dressing.


METHODS
Between October 2005 and July 2006, 852 consecutive patients (605 men; mean age 67 years) undergoing diagnostic or interventional catheterization procedures thru a 5- or 6-F femoral sheath were randomized to one of the 3 closure methods: a collagen plug device (Angio-Seal), a clip (StarClose), or a wound dressing (D-Stat Dry). The efficacy of the devices was assessed, as well as the complications occurring at the puncture site during the hospital stay. The primary endpoint of the study was the cumulative incidence of access site pseudoaneurysm, major access site bleeding requiring transfusion, access site vascular surgery, or death from all causes.


RESULTS
There were no significant differences in baseline characteristics between the 3 treatment groups. The primary endpoint was reached in 20 (7.1%) of 281 patients treated with D-Stat Dry and in 11 (1.9%) of 571 patients treated with the mechanical closure devices (p<0.0001). There was no significant difference among the mechanical closure devices concerning the incidence of the primary endpoint (Angio-Seal 1.1% versus StarClose 2.8%; p = 0.13).


CONCLUSIONS
The collagen plug device had the lowest rates of major and minor access site-related complications after removal of 5- or 6-F femoral sheaths. The difference between the mechanical closure devices concerning the incidence of the primary endpoint did not reach statistical significance. The wound dressing showed significantly higher major and minor complication rates.
Rastan
Aljoscha
A
Abteilung Angiologie, Herz-Zentrum Bad Krozingen, Südring 15, Bad Krozingen, Germany. aljoscha.rastan@herzzentrum.de
Sixt
Sebastian
S
Schwarzwälder
Uwe
U
Schwarz
Thomas
T
Frank
Ulrich
U
Bürgelin
Karlheinz
K
Pochert
Volker
V
Noory
Elias
E
Amantea
Pietro
P
Gremmelmaier
Daniel
D
Müller
Christian
C
Büttner
Heinz-Joachim
HJ
Neumann
Franz-Josef
FJ
Zeller
Thomas
T
D000368:Aged; D000704:Analysis of Variance; D001458:Bandages; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome