title: Use of ultrasound in the insertion of a vascular closure device: a comparative retrospective study with the standard blind technique.
abstract: OBJECTIVE
  To evaluate whether ultrasound (US) assistance can decrease the rate of complications related to the use of vascular closure devices (VCDs).
  
  
  METHODS
  A retrospective comparative study was done on 150 consecutive patients who had a VCD inserted under US guidance after retrograde common-femoral-artery (CFA) puncture. This group was compared to a historical control group of 150 consecutive patients who had the same VCDs inserted with the standard blind technique. After the procedures, patients were placed at bedrest for at least 6 h. Technical success, defined as correct deployment without adjunctive manual compression, blood count and US evaluation of the arterial puncture site was done at 24 h and at 3 months. Differences in terms of efficacy and safety were statistically evaluated using US guidance as a predictor for a lower complication rate.
  
  
  RESULTS
  Technical success was achieved in 147/150 patients (98 %) in the study group vs. 141/150 cases (94 %) of the control group (p = 0.038). In three cases (2 %) adjunctive manual compression (≤5 min) was required. One pseudoaneurysm (0.65 %) occurred after 24 h, solved with manual compression. Six minor complications (4 %)--haematoma (n = 5; 3.35 %), recurrent wound bleeding (n = 1; 0.65 %)--were reported. In the control group four (2.65 %) major complications occurred: CFA occlusion managed with surgical bypass, CFA dissection solved by surgical bypass, two pseudoaneurysms solved with manual compression. Thirteen (8.65 %) minor complications were observed with haematoma (n = 10; 6.65 %), and recurrent wound bleeding (n = 3; 2.0 %). The comparative analysis of the total complication rate and major complication rate between the study group and the control group was statistically significant (p = 0.016 and p = 0.049, respectively). A 24-h evaluation showed a triphasic flow within the CFA in 150/150 patients (100 %) of the study group and in 146/150 cases (97.35 %) of the control group.
  
  
  CONCLUSIONS
  VCD inserted under US guidance increases the success rate reducing the number of complications.
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological Sciences, "Sapienza", University of Rome, 324, Viale Regina Elena, 00161, Rome, Italy, pierleone.lucatelli@gmail.com.
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cannavale
authors.forename: Carlo
authors.initials: C
authors.lastname: Cirelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: d'Adamo
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Salvatori
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
mesh_terms: D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000009:adverse effects; D065506:Vascular Closure Devices / Q000009:adverse effects