Abstract 1780: Use of Arteriotomy Closure Devices and the Risk of Vascular Complications: An Analysis of 227,879 Patients in the ACC-NCDR
INTRODUCTION Arteriotomy closure devices (ACDs) are often used to achieve hemostasis after percutaneous coronary intervention (PCI). Whether ACDs reduce or increase vascular complications is controversial.
METHODS We analyzed data from 227,879 patients in the ACC-NCDR Cath/PCI Registry who underwent PCI via femoral arteriotomy from 1/1/2004 to 3/31/2006. Hemostasis was achieved by manual compression or ACD. The primary endpoint was a composite of any vascular complication: arteriotomy site bleed, retroperitoneal bleed, arterio-venous fistula, pseudoaneurysm, arterial occlusion, and peripheral embolization. We compared unadjusted and adjusted rates of vascular complications in 2 groups, patients treated by manual compression and patients treated with ACDs.
RESULTS Of 227,879 patients, 109,281 (48%) received ACDs, and 118,598 (52%) were treated by manual compression. The composite endpoint of vascular complications was less frequent with ACD use than manual compression. Individual complications that occurred less frequently after ACD use than manual compression include arteriotomy site bleed, arterio-venous fistula, and pseudoaneurysm. Retroperitoneal bleeding was more frequent after ACD use than manual compression. In adjusted analyses, ACDs were independently associated with a lower risk of any vascular complication, entry site bleeding, and pseudoaneurysm, but were associated with an increased risk for retroperitoneal bleeding (see table⇓).
CONCLUSION In clinical practice ACD use was associated with a decreased incidence of all vascular complications, but an increase in retroperitoneal bleeding. These data underscore the need for careful evaluation of the risks and benefits of ACDs for individual patients rather than routine use.