Comments regarding ‘Influence of Use of a Vascular Closure Device on Incidence and Surgical Management of Access Sites. Complications after Percutaneous Interventions’

Abstract

The use of vascular closure devices (VCD) after percutaneous interventions has increased dramatically in the last decade, mainly due to the shorter time to hemostasis, early ambulation, discharge, and increased turnover with reduced staff utilization. Although these devices add to the cost of the procedure, have never been shown to provide added benefit to manual compression significant complications have been reported with their use, their continued utilization reflects the fact that their perceived advantages outweigh the occasional complications that are encountered. The article by Klocker et al. in this issue of EJVES reviewed all patients who required surgery for pseudoaneurysms or local stenosis/occlusion in a very large cohort (n Z 58,453) of patients following percutaneous interventions between 2001e2008, and compared the earlier time period (2001e2004) when a particular collagen-based closure device was sparingly used to the latter time period (2005e2008) of more liberal use of the same device. The study has some major shortcomings: The authors do not have specific data on the actual complication rates following VCD use or manual compression, the sheath size, anticoagulation used, type of intervention other anatomic parameters, and other significant