Vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus arteriotomy closure devices

OBJECTIVES We evaluated the vascular complications after hemostasis with arteriotomy closure devices (ACD) versus manual compression after percutaneous coronary interventions (PCI). BACKGROUND Previous clinical studies have indicated that ACID can be used for achievement of hemostasis and early ambulation after PCI. This study investigated the safety of ACD in achieving hemostasis after PCI compared with manual compression in a large cohort of consecutive patients. METHODS A total of 5,093 patients were followed after PCI was performed with the transfemoral approach. Univariate and multivariate analysis were used to identify the predictors of vascular complications with ACID (n = 516) or with manual compression (n = 5,892) as a hemostasis option after sheath removal. RESULTS The use of ACID was associated with a more frequent occurrence of hematoma compared with manual compression (9.3 vs. 5.1%, p < 0.001). There was also a higher rate of significant hematocrit drop (> 15%) with ACID versus manual compression (5.2% vs. 2.5%, p < 0.001). Similar rates of pseudoaneurysm and arteriovenous fistulae were noted with either hemostasis technique. Vascular surgical repair at the access site was required more often with ACID versus manual compression (2.5 vs. 1.5%, p = 0.03). CONCLUSIONS In this early experience with ACD after PCI, their use was associated with higher vascular complication rates than hemostasis with manual compression. (C) 2001 by the American College of Cardiology.