Should vascular closure devices be the method of choice for closing percutaneous coronary intervention patients

Clin. Pract. (2014) 11(3), 269–271 ISSN 2044-9038 part of Vascular access site complications are an infrequent but persistent complication following cardiac catheterization and percutaneous coronary intervention (PCI). These complications can lead to significant morbidity and mortality with an associated increase in healthcare costs. The use of radial artery access is effective in decreasing vascular site complications. However, a transfemoral approach is still utilized in the majority of patients undergoing cardiac catheterization and coronary intervention. Rates of vascular access site complications and bleeding rates have improved temporally, with the current rate of access site-related bleeding complications following PCI at approximately 2% [1–3]. While more contemporary anticoagulation strategies may account for some of this improvement, the increased use of vascular closure devices (VCDs) likely also plays a role. Since introduction in the early 1990s VCDs have become an increasingly common alternative to manual compression as a means of achieving access site hemostasis. While digital compression remains the ‘gold standard’, other manual compression strategies include devices with both clamp-based and pneumatic compression systems. Distinct from these compression-based strategies, multiple different VCDs have been developed with significant heterogeneity among devices with rapid technological evolution and advancement. These devices typically employ sutures, clips or plugs to achieve arterial hemostasis. Currently available and frequently used devices include the PercloseProGlide (Abbott Vascular, CA, USA) suture-mediated closure system, the StarClose (Abbott Vascular) extravascular nitinol-clip closure system, the Angio-Seal (St Jude Medical, MN, USA) bioabsorbable collagen-plug closure system and the Mynx (AccessClosure) polyethylene glycol-based sealant system. The exact details and specifications of these individual platforms are discussed elsewhere [4,5]. VCDs are typically utilized to provide the benefit of reduced duration of bed rest and arterial compression. Other benefits include improved patient comfort, satisfaction and convenience while affording increased staff availability. VCD use is also expanding as larger caliber arterial access for structural interventions becomes more common, with suture-based preclosure playing an integral role in access management for transcatheter aortic valve replacement [6]. Current guidelines, however, continue to emphasize the use of VCDs primarily for patient comfort and convenience. A 2010 AHA Scientific Statement on the use of arteriotomy closure devices, as well as a 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, both recommend the use of VCDs to achieve more rapid hemostasis and ambulation following transfemoral arterial access after accounting for patient body habitus, arteriotomy location, sheath size and presence of systemic disease (Class IIa, level of evidence [LOE]: B), but not for the purposes of decreasing vascular complications, including bleeding (Class III, LOE: B) [7,8]. Should vascular closure devices be the method of choice for closing percutaneous coronary intervention patients?