Massachusetts Chapter of the American College of Surgeons

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Vascular Closure Devices Are Associated With Fewer Access Site Hematomas After Lower Extremity Revascularization
Thomas W. Cheng1, M.S., Alik Farber1, M.D., M.B.A., Elizabeth G. King1, M.D., Scott R. Levin1, M.D., M.S., Nkiruka Arinze1, M.D., Mahmoud B. Malas2, M.D., Mohammad H. Eslami3, M.D., Karan Garg4, M.D. Denis Rybin5, Ph.D., Jeffrey J. Siracuse1, M.D., M.B.A.
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA; 2Division of Vascular and Endovascular Surgery, University of California San Diego, San Diego, CA; 3Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Division of Vascular Surgery, NYU Langone Medical Center, New York, NY; 5Department of Biostatistics, Boston University, School of Public Health, Boston, MA

Vascular closure devices (VCD) and manual compression (MC) are used to achieve hemostasis following peripheral vascular interventions (PVI). We compared perioperative outcomes between MC and 4 VCDs following PVI in a multicenter setting.

The Vascular Quality Initiative was queried from 2010-2020 for lower extremity (LE) PVIs with common femoral artery access. VCDs included were MynxGrip®, StarClose SE™, Angio-Seal®, and Perclose ProGlide™. In a blinded fashion, these 4 VCDs (A-D) were compared to MC for baseline characteristics, procedure details, and outcomes (access site hematoma and stenosis/occlusion). Sheath size >8 Fr were excluded. Univariable and multivariable analyses were completed.

There were 84,172 LE PVIs identified: 32,013(38%) used MC and in 52,159(62%) a VCD (A-12,675; B-6,224; C-19,872; D-13,388) was used. Overall, average age was 68.7 years; indications for intervention were most commonly claudication (43.8%) and tissue loss (40.1%). VCDs were used more commonly during femoral-popliteal (73% vs. 63.8%) and tibial interventions (33.8% vs. 22.3%), but less commonly with iliac interventions (20.6% vs. 34.7%) (all P<.001). Protamine was used less often after VCDs (19.1% vs. 25.6%,P<.001). There were 2,003(2.4%) hematomas of which 278(13.9%) required thrombin/surgical intervention. Any VCD use, vs. MC, had fewer hematomas (1.7% vs. 3.6%,P<.001) and hematomas requiring intervention (.2% vs. .5%,P<.001). Access site stenosis/occlusion was similar between any VCDs and MC (.2% vs. .2%,P=.12). In multivariable analysis, any VCD, vs. MC, were associated with fewer hematomas, but was similar for access site stenosis/occlusion.

Any VCD use compared favorably to MC with less access site complication after PVI.

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