Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and Meta-Analysis

Abstract

Backgrounds. Manual compression (MC) and vascular closure device (VCD) are two methods of vascular access site hemostasis after cardiac interventional procedures. However, there is still controversial over the use of them and a lack of comprehensive and systematic meta-analysis on this issue. Methods. Original articles comparing VCD and MC in cardiac interventional procedures were searched in PubMed, EMbase, Cochrane Library, and Web of Science through April 2022. Efficacy, safety, patient satisfaction, and other parameters were assessed between two groups. Heterogeneity among studies was evaluated by I2 index and the Cochran Q test, respectively. Publication bias was assessed using the funnel plot and Egger’s test. Results. A total of 32 studies were included after screening with inclusion and exclusion criteria (33481 patients). This meta-analysis found that VCD resulted in shorter time to hemostasis, ambulation, and discharge ( p < 0.00001 ). In terms of vascular complication risks, VCD group might be associated with a lower risk of major complications ( p = 0.0001 ), but the analysis limited to randomized controlled trials did not support this result ( p = 0.68 ). There was no significant difference in total complication rates ( p = 0.08 ) and bleeding-related complication rates ( p = 0.05 ) between the two groups. Patient satisfaction was higher in VCD group ( p = 0.002 ). Meta-regression analysis revealed no specific covariate as an influencing factor for above results ( p > 0.05 ). Conclusions. Compared with MC, the use of VCDs significantly shortens the time of hemostasis and allows earlier ambulation and discharge, meanwhile without increase in vascular complications. In addition, use of VCDs achieves higher patient satisfaction and leads cost savings for patients and institutions.

Efficacy and Safety of Axiostat® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers

“…MC is often time-consuming [ 18 , 48 ], an element that assumes particular importance in night procedures and in conditions of staff shortage and overlapping between several urgent procedures. From the patient’s perspective, MC is often significantly painful with a prolonged TTH and requires long bed rest afterwards with delayed TTA and time-to-discharge (TTD) [ 13 , 18 , 49 ]. Furthermore, during the period of forced bed rest, the patient often complains of discomfort due to back pain, an inconvenient diet, dysuria and difficult defecation [ 50 , 51 ].…”

“…Several investigators advocated the utility of VCDs, as shortened TTH, TTA and TTD are noted [ 13 , 14 , 15 , 16 , 17 , 18 ]. Increased [ 52 ], or at least not decreased [ 48 ], VASCs have been observed with the use of first-generation VCDs.…”

“…Jakobsen et al noted a median TTH of 4 min (IQR, 3–5) in 432 patients undergoing vascular access site hemostasis with the extravascular VCD MynxGrip ® [ 55 ]. A recent meta-analysis by Pang et al confirmed the advantages of TTH and TTA of the VCDs over the MC [ 18 ]. Interestingly, we observed reduced TTH with Axiostat ® -aided MC compared to MC alone, as assessed by other reports.…”

“…Postoperative hemostasis maintenance can be indirectly assessed by bleeding-related VASCs, which can serve as surrogate markers [ 18 ]. In our investigation, bleeding-related VASCs were observed in seven (5.8%) cases and VASCs in 10 (8.3%) cases, in keeping with the current literature [ 56 , 57 ].…”

“…After the removal of the introducer sheath, achieving hemostasis of the vascular access site by manual compression (MC) or a vascular closure device (VCD) is critical to the safe completion of any endovascular procedure [ 13 ]. Although time-to-ambulation (TTA) and time-to-hemostasis (TTH) are significantly shortened by the use of VCDs, the incidence of vascular access site complications (VASCs) remains between 5% and 12% [ 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Furthermore, the technical failure of VCDs is around 1.1–8.7% [ 11 , 14 , 15 , 16 , 17 , 21 , 23 ].…”