Use of ultrasound in the insertion of a vascular closure device: a comparative retrospective study with the standard blind technique

• DOI: 10.1007/s11547-014-0439-3
• Publication Date: 2014-08-14T06:48:30Z
• Authors: Pierleone Lucatelli; Alessandro Cannavale; Carlo Cirelli; Alessandro d’Adamo; Filippo Maria Sal...; Fabrizio Fanelli
• Keywords: Adult; Male; Hematoma; Hemostasis; Time Factors; Angioseal VIP; FemoSeal; Perclose Proglide; Starclose SE; Ultrasound guidance; Vascular closure devices; Adult; Aged; Aneurysm, False; Female; Femoral Artery; Follow-Up Studies; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Punctures; Reproducibility of Results; Retrospective Studies; Risk Factors; Time Factors; Hemostasis; Ultrasonography, Interventional; Vascular Closure Devices; Radiology, Nuclear Medicine and Imaging; Medicine (all); Reproducibility of Results; Hemorrhage; Punctures; Middle Aged; 3. Good health; Femoral Artery; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Humans; Female; Aneurysm, False; Ultrasonography, Interventional; Vascular Closure Devices; Aged; Follow-Up Studies; Retrospective Studies

To evaluate whether ultrasound (US) assistance can decrease the rate of complications related to the use of vascular closure devices (VCDs).A retrospective comparative study was done on 150 consecutive patients who had a VCD inserted under US guidance after retrograde common-femoral-artery (CFA) puncture. This group was compared to a historical control group of 150 consecutive patients who had the same VCDs inserted with the standard blind technique. After the procedures, patients were placed at bedrest for at least 6 h. Technical success, defined as correct deployment without adjunctive manual compression, blood count and US evaluation of the arterial puncture site was done at 24 h and at 3 months. Differences in terms of efficacy and safety were statistically evaluated using US guidance as a predictor for a lower complication rate.Technical success was achieved in 147/150 patients (98 %) in the study group vs. 141/150 cases (94 %) of the control group (p = 0.038). In three cases (2 %) adjunctive manual compression (≤5 min) was required. One pseudoaneurysm (0.65 %) occurred after 24 h, solved with manual compression. Six minor complications (4 %)--haematoma (n = 5; 3.35 %), recurrent wound bleeding (n = 1; 0.65 %)--were reported. In the control group four (2.65 %) major complications occurred: CFA occlusion managed with surgical bypass, CFA dissection solved by surgical bypass, two pseudoaneurysms solved with manual compression. Thirteen (8.65 %) minor complications were observed with haematoma (n = 10; 6.65 %), and recurrent wound bleeding (n = 3; 2.0 %). The comparative analysis of the total complication rate and major complication rate between the study group and the control group was statistically significant (p = 0.016 and p = 0.049, respectively). A 24-h evaluation showed a triphasic flow within the CFA in 150/150 patients (100 %) of the study group and in 146/150 cases (97.35 %) of the control group.VCD inserted under US guidance increases the success rate reducing the number of complications.