The Use of Vascular Closure Devices for Brachial Artery Access: A Systematic Review and Meta-Analysis |
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| Affiliation: | 1. Department of Radiology, McMaster University, Hamilton, Ontario, Canada;2. Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada;3. Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada;1. Long Island Jewish Medical Center, Northwell Health System, Queens, New York;2. New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York;3. Zucker School of Medicine at Hofstra University/Northwell Health System, Hempstead, New York;4. Icahn School of Medicine at Mount Sinai Hospital, New York, New York;1. Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania;4. Division of Vascular and Interventional Radiology, Department of Radiology, University of California San Diego, La Jolla, California;1. Interventional Radiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana;2. Vascular and Interventional Specialists, Charlotte Radiology, Charlotte, North Carolina;3. Interventional Radiology, Northwestern Medicine, Palos Health, Palos Heights, Illinois;4. Los Angeles Imaging and Interventional Consultants, PIH Health, Whittier, California;5. Gastroenterology and Hepatology, Atrium Health, Charlotte, North Carolina;6. Division of Hepatobiliary and Pancreas Surgery, Atrium Health, Charlotte, North Carolina;1. Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico;2. Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland;1. Department of Radiology, Kaiser Permanente Oakland Medical Center, Oakland, California;2. Department of Radiology, Kaiser Permanente Richmond Medical Center, Richmond, California;3. Department of Psychology, George Mason University, Fairfax, Virginia |
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| Abstract: | PurposeTo estimate the rates of technical success and adverse events of vascular closure devices (VCDs) in the brachial artery and compare the rates of adverse events with manual compression.Materials and MethodsMEDLINE and Embase were searched for observational studies examining VCDs in the brachial artery. Meta-analyses were performed using random effects for the following outcomes: (a) technical success, (b) hematoma at the access site, (c) pseudoaneurysm, (d) local neurological adverse events, and (e) total number of adverse events. A pairwise meta-analysis compared VCD with manual compression for the outcomes of hematoma and the total number of adverse events.ResultsOf 1,761 eligible records, 16 studies including 510 access sites were included. Primary procedures performed were peripheral arterial disease interventions, percutaneous coronary intervention, and endovascular thrombectomy for ischemic stroke. The technical success rate was 93% (95% CI, 87%–96%; I2 = 47%). Data on the following adverse events were obtained via meta-analysis: (a) hematoma, 9% (5%–15%; I2 = 54%); (b) stenosis or occlusion at access site, 3% (1%–14%; I2 = 51%); (c) infection, 0% (0%–5%; I2 = 0%); (d) pseudoaneurysm, 4% (1%–13%; I2 = 61%); (e) local neurological adverse events, 5% (2%–13%; I2 = 54%); and (f) total number of adverse events, 15% (10%–22%; I2 = 51%). Angio-Seal success rate was 96% (93%–98%; I2 = 0%), whereas the ExoSeal success rate was 93% (69%–99%; I2 = 61%). When comparing VCD and manual compression, there was no difference in hematoma formation (relative risk, 0.75; 95% CI, 0.35–1.63; I2 = 0%; P = .47) or the total number of adverse events (relative risk, 0.75; 95% CI, 0.35–1.58; I2 = 76%; P = .45).ConclusionsDespite being off-label, studies suggest that VCDs in the brachial artery have a high technical success rate. There was no significant difference in adverse events between VCDs and manual compression in the brachial artery. |
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