Comparison of Arterial Closure Devices in Antegrade and Retrograde Punctures

Abstract

Angio-Seal had a lower rate of primary failure than Perclose in antegrade puncture closures. We believe this reinforces the need for larger studies to compare closure devices in antegrade punctures.

Access site management with vascular closure devices for percutaneous transarterial procedures

“…While several clinical studies reported device success rates ranging from 90% to 100% which is similar to other devices. 22,48,[58][59][60][61][62] Device failure, while uncommon, has been attributed to suture breakage or failure to create a secured knot. If the Perclose device fails, MC can achieve hemostasis.…”

“…63 Comparative studies between the Perclose device vs manual compression noted a faster time to achieve hemostasis and ambulation when using the Perclose device. 22,48,[58][59][60][61][62] There are multiple small randomized studies comparing Perclose to MC in the setting of diagnostic angiography, PCI, and both. The results are mixed; some favor Perclose with fewer complications 41,52,64,65 and others favor MC.…”

“…Similar to other devices, this device can achieve a high degree of success even in patients who receive anticoagulation. 22,48,[58][59][60][61][62] An unusual complication of femoral arteritis has been reported with early platform of Perclose device which used a braided suture. 48,69,70 The introduction of the ProGlide model, which incorporated an improved suture trimming mechanism and replaced braided suture with monofilament polypropylene suture, has reduced the incidence of device failure and lowered the risk of infectious complication.…”

Commentary: Shutting the Door After Antegrade Femoral Arteriotomy: Should You Push, Clip, Tie, or Plug?

“…9,10 Whereas limited data in support of Perclose and StarClose (both from Abbott Vascular, Santa Clara, CA, USA) have been reported, the use of Angio-Seal (St. Jude Medical) has been described in a series of previous reports, suggesting, albeit inconclusively, its feasibility and safety in this setting. [11][12][13] This issue of the Journal reports a compelling single-center cohort study by Lupattelli et al, 14 enrolling 1626 patients undergoing one or more duplex ultrasound-guided antegrade femoral punctures for lower limb revascularization. This registry showed that, in experienced hands, antegrade Angio-Seal deployment can successfully achieve hemostasis in 97.9% of cases, with a 1.1% rate of early complications, a 2.5% rate of 30-day complications, and no later complications associated with the device.…”

Percutaneous Vascular Closure Using an Anchored Collagen Plug Provides Effective Haemostasis Following both Antegrade and Retrograde Femoral Arterial Punctures

“…Smaller series have examined the efficacy of deployment of such devices, typified here by the Angio-Seal VIP ("V-Twist Integrated Platform"; St. Jude Medical, Minnetonka, MN, USA). However, there are limited published data, with heterogeneity of study parameters, comparing it to manual compression, 1e3 to other VCDs, 4 or simply registries. 5 There is also very limited data so far comparing the efficacy of the Angio-Seal (now used to imply the Angio-Seal VIP throughout) VCD between retrograde and antegrade punctures.…”