title: A systematic review on the safety of Prostar XL versus ProGlide after TAVR and EVAR.
abstract: BACKGROUND
  Endovascular aortic aneurysm repair (EVAR) and transfemoral transcatheter aortic valve replacement (TAVR) are widely spreading minimally invasive procedures performed mainly through the femoral artery. Prostar XL and ProGlide vascular closure devices are used in clinical practice for the hemostasis in these procedures and they have been shown to be safe and effective.
  
  
  OBJECTIVE
  The aim of our systematic review is to compare the safety of these two devices for percutaneous closure of large arteriotomies in patients undergoing TAVR and EVAR.
  
  
  METHODS
  We searched PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials for all randomized and observational published studies that compared Prostar XL vs. ProGlide. Relative risk was calculated by random-effects model. Review Manager 5.1 was used for statistical analysis.
  
  
  RESULTS
  A total number of 2909 patients were included in our analysis. The rate of overall vascular complications did not differ between Prostar XL and ProGlide {RR 1.35 (0.80-2.29), p=0.27}. In contrary, the risk ratio of all bleeding complications with Prostar XL compared to ProGlide was 1.82 (1.47-2.24, p<0.001) and for major and life-threatening bleeding complications was 2.48 (1.65-3.73, p<0001, suggesting a lower bleeding risk with ProGlide). No statistical difference was found between groups for end-stage acute kidney injury (AKI), with a risk ratio of 2.14 (0.81-5.66), p=0.05. Finally, there were no differences in in-hospital and 30-days mortality rate between the two groups (1.41, 0.56-3.54, p=0.46 and 1.43, 0.55-3.73, p=0.47, respectively).
  
  
  CONCLUSIONS
  Prostar XL is associated with greater risk of any bleeding as well as life threatening bleeding compared to the ProGlide device. However, no significant differences were observed in the rate of overall vascular complications, end stage AKI and in-hospital and 30-days mortality.
authors.affiliation: 2nd Cardiology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Maniotis
authors.affiliation: Interventional Cardiology Department, University Hospital of Leiden, Leiden, The Netherlands.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Andreou
authors.affiliation: Interventional Cardiology Department, University Hospital of Leiden, Leiden, The Netherlands.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Karalis
authors.affiliation: Interventional Radiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Giasemi
authors.initials: G
authors.lastname: Koutouzi
authors.affiliation: 2nd Cardiology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Agelaki
authors.affiliation: 2nd Cardiology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece. Electronic address: koutouzismike@yahoo.gr.
authors.forename: Michael
authors.initials: M
authors.lastname: Koutouzis
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D057510:Endovascular Procedures; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome; D065506:Vascular Closure Devices
keywords: EVAR; Proglide; Prostar XL; TAVR