Practices and Complications of Vascular Closure Devices and Manual Compression in Patients Undergoing Elective Transfemoral Coronary Procedures

Comparison of Exo-Seal® and Angio-Seal® for arterial puncture site closure

“…In the meta-analysis of Smilowitz et al, failure of device implantation was reported to be in the range of 1.23 % [27]. Implantation failure in the AngioSeal  group was 1.2 %, being exactly in the range of this analysis.…”

“…The most recent meta-analyses still remain conflicting. Smilowitz and coworkers found closure devices to be associated with significantly lower rates of vascular complications compared with primary hemostasis with manual compression [27], while Byrne et al found that the data do not demonstrate consistent reductions in access-site complications [4]. Biancari et al reported equal or higher rates of complications [28].…”

“…In a meta-analysis of 12,937 patients undergoing either manual compression or vascular closure, Arora et al reported complication rates of 2.4 % after PCI and vascular closure with different devices [15]. In the meta-analysis of Smilowitz et al, the complication rate was 0.87 % with a PCI rate of 34.8 % [27]. Overall, complications are reported to be between 0.5 and 1.8 % after angiography and 0.6 and 9 % after PCI [15,31].…”

Direct Puncture of a Surgically-exposed Femoral Artery Graft for Simultaneous Stenting of Coronary, Carotid and Innominate Artery Stenoses

“…Nevertheless, this incidence is significant when compared with puncture site complication rate of 0.81%-2.6% in the setting of conventional femoral artery puncture. 9,10) Because greater than 90% of these graft punctured cases had employed manual compression for hemostasis, our case suggests that direct graft puncture with surgical exposure and hemostasis with purse string suture may be safer. However, there is one report of pseudoaneurysm forsite complications in 11 (11.6%) of 95 patients including eight with subcutaneous hematoma ≤5 cm in diameter, one with graft thrombosis requiring thrombolytic therapy, one with catheter breakage, and one with infection.…”

Angio-seal infection: An uncommon but serious and alarming complication of vascular closure devices

“…Complications associated with the use of these devices include bleeding, hematoma, aneurysm, infection, arterio-venous fistula, allergic reaction, and foreign body reaction [3]. A study performed to estimate the rate of complications revealed that 2% of the patients develop the above-mentioned complications and infections account for about 0.3% of these complications [4].…”