Abstract:

Introduction: vascular closure devices (VCD) for over 20 years have been used as an alternative to manual compression to achieve hemostasis. Despite the fact that clinical efficacy and safety of occlusive type VCD have been confirmed in a number of studies, their use remains controversial due to the formation of complications at the access site when using these devices.

Aim: was to estimate possible advantages and limitations of vascular closure devices of occlusive type (Angio-Seal) in patients, who had underwent percutaneous coronary interventions (PCI) via femoral access in comparison with traditional manual hemostasis.

Material and methods: data of 231 adult patients who underwent therapeutic endovascular procedures in the City Hospital named after M.P. Konchalovsky, Research and Development Center for Preventive Medicine were selected for retrospective research. The main group, with hemostasis after PCI with Angio-Seal (Terumo) obturating device, consisted of 113 patients, control group - included 118 patients with manual hemostasis. Subjective sensations (pain, numbness, etc.), complication rate, hemostasis time, immobilization and hospitalization duration were evaluated.

Results: success of using VCD was 98.23%, complication rate in the main group was 4.37%, in the control group - 6.78% (however, it was not reliable). The time of hemostasis (2.1 min versus 22.25 min), immobilization (3.5 hours versus 20.6 hours) and hospitalization (4 days versus 8 days) significantly decreased, and the patient comfort level was significantly higher in the main group.

Conclusions: the use of Angio-Seal VCD in patients after percutaneous transfemoral therapeutic endovascular procedures is an effective way to reduce hemostasis time in comparison with using of manual compression; allows to reduce patient's immobilization period, significantly increases patient comfort, and reduces patient's hospital stay.

Along with this procedure, it should be considered as an independent surgical intervention and surgeon should follow all necessary rules and stages of its implementation, should control result of hemostasis.

References

1.     Bockeria LA, Alekyan BG. State of endovascular diagnosis and treatment of cardiac and vascular diseases in the Russian Federation (2014). Russian Journal of Endovascular Surgery 2015; 2(1-2):5-20 [In Russ].

2.     Byrne RA, Cassese S, Linhardt M, Kastrati A. Vascular access and closure in coronary angiography and percutaneous intervention. Nat Rev Cardiol. 2013; 10(1):27-40.

3.     Semitko SP, Gubenko IM, Analeev AI, Azarov AV, Maiskov VV, Karpun NA, Iosseliani DG. Vascular complications of percutaneous coronary interventions and clinical results of the use of various devices providing hemostasis. Consilium medicum 2012; 14(10): 51-57 [In Russ].

4.     Dauerman HL, Applegate RJ, Cohen DJ. Vascular closure devices: the second decade. J Am Coll Cardiol. 2007; 50(17):1617-1626.

5.     Biancari F, D’Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010; 159(4): 518-531.

6.     Ndrepepa G, Berger PB, Mehilli J et al. Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions: appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol 2008; 51:690.

7.     Rao SV, Kedev S. Approaching the post-femoral era for coronary angiography and intervention. JACC Cardiovasc. Interv. 2015; 8: 524–526.

8.     Lo TS et al. Radial artery anomaly and its influence on transradial coronary procedural outcome. Heart 2009; 95(5): 410–415.

9.     Sciahbasi A et al. Transradial approach (left versus right) and procedural times during percutaneous coronary procedures: TALENT study. Am. Heart J. 2011; 161: 172–179.