title: The frequency of vascular complications associated with the use of vascular closure devices varies by indication for cardiac catheterization.
abstract: OBJECTIVE
  This study aimed at exploring access site-related vascular complication rates associated with the use of the vascular closure device (VCD) Angio-Seal™ in an unselected patient population undergoing elective as well as emergency coronary angiography or intervention.
  
  
  BACKGROUND
  The VCD Angio-Seal™ is widely used to achieve hemostasis after diagnostic and interventional cardiac procedures. There are only little data on the frequency of vascular complications after the use of the VCD Angio-Seal™ in patients in non-elective settings.
  
  
  METHODS
  In-hospital vascular complications were prospectively assessed in 4,653 consecutive cardiac catheterization procedures, which included 2,772 elective diagnostic and 960 elective percutaneous coronary interventions (PCI), and 921 emergency cardiac catheterizations in patients with NSTEMI/STEMI. In 2,077 procedures manual compression (MC) and in 2,576 procedures VCD was applied. Complication rates for manual compression and VCD use were studied and multivariate analyses performed to disclose predictors for access site-related vascular complications.
  
  
  RESULTS
  Vascular complication rates in patients receiving MC to achieve hemostasis were similar to those receiving a VCD (MC 3.4% vs. VCD 3.2%, p = n.s.). Separate analysis of vascular complication rates for subgroups revealed a significant reduction in vascular complications for the PCI group using a VCD (MC 7.7% vs. VCD 3.2%, p = 0.003). In emergencies VCD use lead to a rise in vascular complications (MC 0.9% vs. VCD 6.3%, p < 0.001).
  
  
  CONCLUSIONS
  In contrast to elective settings, the risk of access site-related vascular complications is significantly increased after application of the VCD Angio-Seal™ in patients undergoing emergency catheterizations for NSTEMI/STEMI compared with manual compression.
authors.affiliation: Medizinische Klinik I, Medical Faculty, University RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany. estegemann@ukaachen.de
authors.forename: Emilia
authors.initials: E
authors.lastname: Stegemann
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Steven
authors.initials: S
authors.lastname: Marso
authors.forename: Berthold
authors.initials: B
authors.lastname: Stegemann
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauer
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006489:Hemostatic Techniques / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis; D011446:Prospective Studies; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology*