Closure of the femoral artery after cardiac catheterization: a comparison of Angio-Seal, StarClose, and manual compression.
OBJECTIVE
To compare Angio-Seal (AS) and StarClose (SC) and manual compression (MC) on efficacy of hemostasis, complication rate, safety of early mobilization, and patient comfort.


BACKGROUND
Closure of the femoral artery after cardiac catheterization can be obtained through different methods. Today, physicians can choose from a number of different devices to achieve arterial closure.


METHODS
In a prospective trial 450 patients were randomized to AS, SC, or MC. Patients were mobilized 1 to 2 hr after device placement, and 6 hr after MC. Data were collected during hospital admission and by telephone at one month after hospital discharge.


RESULTS
Devices were used in 138/150 allocated to AS and 124/150 allocated to SC patients (92% vs. 83%, P = 0.015) Patients with MC experienced more pain during sheath removal than patients receiving a device, and rated their period of bed rest as less comfortable. Oozing and need for pressure bandage at the puncture site were observed in 37 AS patients and 57 SC patients (25% vs. 38%, P = 0.002). Hematoma occurred in 15 AS patients, in 17 SC patients, and in 14 MC patients (11 vs. 14 vs. 9%, ns).


CONCLUSIONS
There is no difference in safety between the three methods of arterial closure. SC was more often not used or successfully deployed. SC patients more often had continuing oozing. On patient comfort, closure devices performed better than MC. Early ambulation in patients with a closure device is safe. AS is the preferred method of arterial closure after cardiac catheterization.
Deuling
J H H
JH
Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, The Netherlands. j.h.h.deuling@thorax.umcg.nl
Vermeulen
R P
RP
Anthonio
R A
RA
van den Heuvel
A F M
AF
Jaarsma
T
T
Jessurun
G
G
de Smet
B J G L
BJ
Tan
E S
ES
Zijlstra
F
F
D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D004434:Early Ambulation; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006406:Hematoma / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011312:Pressure; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects*; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome