4:21 PM Abstract No. 51 Safety and efficacy of arterial closure devices following antegrade femoral access: a case-control study

Abstract

Vascular closure device (VCD) use following antegrade femoral access is not indicated by the Food and Drug Administration, and may present unique anatomic challenges relative to retrograde access. We compared safety and efficacy of three devices between antegrade and retrograde access cohorts undergoing percutaneous intervention. A consecutive series of 107 limbs in 84 patients underwent VCD arteriotomy closure following percutaneous revascularization using an antegrade approach (VCD-A). These were compared with a contemporaneous control group of 402 limbs in 306 patients who underwent closure following retrograde access (VCD-R) (n = 509) during revascularization and/or embolization procedures. Device deployment success, patient time to ambulation, and major/minor complications were compared between the two groups. Antegrade closure was attempted in the VCD-A cohort using 53 StarClose (Abbott, Santa Clara, CA), 35 Perclose (Abbott), and 19 Angio-Seal (Terumo, Somerset, NJ) devices. Hemostasis (without supplemental manual compression) was achieved in 86/107 (80.4%) limbs. In the VCD-R group, closure was attempted using 215 StarClose, 120 Perclose, and 67 Angio-Seal devices, with hemostasis achieved in 357/402 (88.8%) limbs without supplemental manual compression. Device deployment failure occurred in 7/107 (6.5%) of VCD-A patients and 20/402 (5.0%) of VCD-R patients (P = 0.48). Femoral pseudoaneurysm developed in 1/107 and 1/402 of VCD-A and VCD-R patients (P = 0.38). Major hematoma requiring further intervention developed in 1/107 and 1/402 of VCD-A and VCD-R patients (P = 0.38), and minor hematoma not requiring further intervention developed in 3/107 and 8/402 of the VCD-A and VCD-R (P = 0.71). Mean time to ambulation was 204.1 minutes in the VCD-A group and 204.8 minutes in VCD-R (P = 0.97). In both VCD-R and VCD-A groups, the StarClose, Perclose, and Angio-Seal devices were associated with similar rates of deployment failure (P = 0.080; P = 0.67). Antegrade femoral closure among the studied devices was associated with high rates of technical success and low complications, similar to retrograde closure. Time to ambulation was similar among VCD-A and VCD-R groups.Tabled 1ComplicationVCD-R (n = 402)VCD-A (n = 107)PDevice failure2070.48Pseudoaneurysm110.38Major hematoma110.38Minor hematoma830.71Supplemental manual compression25140.030 Open table in a new tab