title: Practices and complications of vascular closure devices and manual compression in patients undergoing elective transfemoral coronary procedures.
abstract: Femoral arterial puncture is the most common access method for coronary angiography and percutaneous coronary interventions (PCIs). Access complications, although infrequent, affect morbidity, mortality, costs, and length of hospital stay. Vascular closure devices (VCDs) are used for rapid hemostasis and early ambulation, but there is no consensus on whether VCDs are superior to manual compression (MC). A retrospective review and nested case-control study of consecutive patients undergoing elective transfemoral coronary angiography and PCI over 3 years was performed. Hemostasis strategy was performed according to the operators' discretion. Vascular complications were defined as groin bleeding (hematoma, hemoglobin decrease ≥3 g/dl, transfusion, retroperitoneal bleeding, or arterial perforation), pseudoaneurysm, arteriovenous fistula formation, obstruction, or infection. Patients with postprocedure femoral vascular access complications were compared to randomly selected patients without complication. Data were available for 9,108 procedures, of which PCI was performed in 3,172 (34.8%). MC was performed in 2,581 (28.3%) and VCDs (4 different types) were deployed in 6,527 procedures (71.7%). Significant complications occurred in 74 procedures (0.81%), with 32 (1.24%) complications with MC and 42 (0.64%) with VCD (p = 0.004). VCD deployment failed in 80 procedures (1.23%), of which 8 (10%) had vascular complications. VCD use was a predictor of fewer complications (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). In the case-control analysis, older age and use of large (7Fr to 8Fr) femoral sheaths were independent predictors of complications. In conclusion, the retrospective analysis of contemporary hemostasis strategies and outcomes in elective coronary procedures identified a low rate of complications (0.81%), with superior results after VCD deployment. Careful selection of hemostasis strategy and closure device may further decrease complication rates.
authors.affiliation: Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Smilowitz
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Michael
authors.initials: M
authors.lastname: Guiry
authors.forename: William A
authors.initials: WA
authors.lastname: Gray
authors.forename: Pilar
authors.initials: P
authors.lastname: Dolcimascolo
authors.forename: Michael
authors.initials: M
authors.lastname: Querijero
authors.forename: Claudia
authors.initials: C
authors.lastname: Echeverry
authors.forename: Nellie
authors.initials: N
authors.lastname: Kalcheva
authors.forename: Braulio
authors.initials: B
authors.lastname: Flores
authors.forename: Varinder P
authors.initials: VP
authors.lastname: Singh
authors.forename: Leroy
authors.initials: L
authors.lastname: Rabbani
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.forename: Michael B
authors.initials: MB
authors.lastname: Collins
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001803:Blood Transfusion; D016022:Case-Control Studies; D055499:Catheter-Related Infections; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006454:Hemoglobins / Q000032:analysis; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000209:etiology*
chemical_list: D006454:Hemoglobins