title: Percutaneous vascular closure using an anchored collagen plug provides effective haemostasis following both antegrade and retrograde femoral arterial punctures.
abstract: OBJECTIVE
  Small published series suggest a higher failure rate for Angio-Seal vascular closure device (VCD) deployment after antegrade femoral puncture, despite the need for shorter haemostasis times, early discharge, and possibly higher turnover. We seek to compare the deployment efficacy and complications of the Angio-Seal VCD between antegrade and retrograde femoral arterial deployments.
  
  
  METHODS
  Radiological data was retrospectively analysed from prospective databases from the hospitals' Computerised Radiology Information System (CRIS) over 2010-2012. Angio-Seal gauge, Rutherford class (as applicable), puncture mode (used to classify deployment as antegrade/retrograde), sheath sizes, and deployment success/failures were recorded. Numerical/statistical analyses were undertaken using Microsoft Excel 10/SISA software.
  
  
  RESULTS
  A total of 519 Angio-Seal VIP VCDs were deployed in 470 patients over 2010-2012 (13 other patients could not be analysed due to incomplete data). Sheath sizes for antegrade/retrograde femoral puncture were 5F, n = 22/9; 6F, n = 244/223; 7F, n = 1/5; 9F, n = 4/0. 8F Angio-Seal VIPs were used for 9F punctures only, 6F for the remainder. The overall deployment success rate was 93.7%. In total, 247 (91.1%) successful antegrade deployments were undertaken with 24 (8.9%) failures, compared with 229 (96.6%) successful retrograde deployments with eight (3.4%) failures. Antegrade/retrograde failures were classed as failure to deploy, n = 15/5; bleeding despite successful deployment requiring supplementary compression, n = 6/1; haematoma formation, n = 2/1; groin pain, n = 0/1; vessel stenosis, n = 1/0. Higher deployment failures were noted with antegrade deployment (p < .02, chi-square test).
  
  
  CONCLUSIONS
  Angio-Seal deployment is successful for both antegrade/retrograde femoral punctures albeit with a higher antegrade failure rate.
authors.affiliation: Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, UK. Electronic address: a.chaudhuri@ntlworld.com.
authors.forename: A
authors.initials: A
authors.lastname: Chaudhuri
authors.affiliation: Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, UK.
authors.forename: A
authors.initials: A
authors.lastname: York
authors.affiliation: Department of Radiology, Northampton General Hospital, Cliftonville Road, Northampton, UK.
authors.forename: R
authors.initials: R
authors.lastname: Dey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006489:Hemostatic Techniques / Q000009:adverse effects; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D011873:Radiology Information Systems; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D003094:Collagen
keywords: Angio-Seal; Angiography/angioplasty; Femoral artery puncture; Hemostasis; Vascular closure device