title: Simplified swift and safe vascular closure device deployment without a local arteriogram: Single center experience in 2074 consecutive patients.
abstract: OBJECTIVE
  Vascular closure devices (VCDs), such as the Angio-Seal, a three-component hemostatic plug, have greatly facilitated the routine clinical practice in the catheterization laboratory. The manufacturer recommends a local angiogram before Angio-Seal deployment. However, from the outset, we employed a simplified routine of deploying this VCD, i.e. without use of local angiography.
  
  
  METHODS
  The Angio-Seal was employed without a preceding femoral arteriogram over 8 years in 2074 consecutive patients, 72% presenting with acute coronary syndromes and subjected to coronary angiography (n=1032) or PCI n=1042) via a transfemoral approach with use of heparin and dual antiplatelet therapy.
  
  
  RESULTS
  Deployment of the VCD was successful in 99.4%. Complete hemostasis was obtained in 98% of cases. In 14 patients, Angio-Seal deployment failed. Mean time for placement of Angio-Seal was <1min, to-hemostasis 1min, and to-mobilization 3h. Only 3 (0.15%) patients had a major complication with vessel occlusion that required emergent vascular surgery with a successful outcome. Two patients developed a local pseudoaneurysm treated with ultrasonography-guided compression. Six small and 4 large inguinal hematomas (one requiring blood transfusion) and 5 cases of retroperitoneal bleeding (one requiring blood transfusion) were recorded.
  
  
  CONCLUSIONS
  Deployment of Angio-Seal without use of local angiography was efficacious and safe, characterized by a high success rate of deployment and hemostasis with few correctable complications in a large patient cohort undergoing transfemoral catheterization for PCI and non-PCI procedures under anticoagulation and antiplatelet drug therapy. VCD reduced the time-to-hemostasis and time-to-mobilization and minimized the incidence of complications.
authors.affiliation: Third Department of Cardiology, Athens University School of Medicine and First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece. Electronic address: asm@otenet.gr.
authors.forename: Antonis S
authors.initials: AS
authors.lastname: Manolis
authors.affiliation: Third Department of Cardiology, Athens University School of Medicine and First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Georgiopoulos
authors.affiliation: Third Department of Cardiology, Athens University School of Medicine and First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Stalikas
authors.affiliation: Third Department of Cardiology, Athens University School of Medicine and First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Koulouris
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011677:Punctures; D012307:Risk Factors; D013997:Time Factors; D065506:Vascular Closure Devices; D055815:Young Adult
keywords: Angio-Seal; Cardiac catheterization; Percutaneous coronary intervention; Transfemoral technique; Vascular closure device