Sanghamitra Mohanty1,2, Chintan Trivedi1, Salwa Beheiry1, Amin Al-Ahmad1, Rodney Horton1, Domenico G Della Rocca1, Carola Gianni1, Alessio Gasperetti3, Mustafa Abdul-Moheeth4, Mintu Turakhia5, Andrea Natale1,2,5,6,7. 1. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA. 2. Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA. 3. University of Milan, Milan, Italy. 4. Texas A & M College of Medicine, Bryan, TX, USA. 5. Division of Cardiology, Stanford University, Palo Alto, CA, USA. 6. Case Western Reserve University, Cleveland, OH, USA. 7. Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA.
Abstract
AIMS: Manual compression (MC), widely used to achieve venous access haemostasis, needs prolonged immobilization and extended time-to-haemostasis. Vascular closure devices (VCD) have been reported to have significantly shorter time to haemostasis and ambulation in arterial access-site management. The current study aimed to evaluate the safety and efficacy as well as rate of urinary tract complications in patients receiving MC vs. VCD for venous access-site closure. METHODS AND RESULTS: A total of 803 consecutive patients undergoing catheter ablation or left atrial appendage closure were classified into the VCD (n = 304) and the MC (n = 499) group, based on the methods used for haemostasis at the venous access site. Foley catheter was used for bladder-emptying in all MC cases and 15 VCD patients. At one site, VCD group patients with experience of MC in prior ablations were asked to describe their overall satisfaction level after comparing the past experience with the present. Haemostasis was achieved effectively in both populations. No VCD cases required >2 h bed rest, whereas 7 (1.4%) patients in the MC group needed prolonged immobilization (P = 0.04). Significantly higher incidence of access-site haematoma (P = 0.004) and urinary complications (P < 0.05) were observed in the MC group. Majority of VCD patients (68%) with prior experience of MC for haemostasis expressed satisfaction over the early ambulation and ability to void urine without bladder catheterization. CONCLUSION: Vascular closure devices provided effective haemostasis, while reducing the access-site complications, ambulation time, and urinary complications. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Manual compression (MC), widely used to achieve venous access haemostasis, needs prolonged immobilization and extended time-to-haemostasis. Vascular closure devices (VCD) have been reported to have significantly shorter time to haemostasis and ambulation in arterial access-site management. The current study aimed to evaluate the safety and efficacy as well as rate of urinary tract complications in patients receiving MC vs. VCD for venous access-site closure. METHODS AND RESULTS: A total of 803 consecutive patients undergoing catheter ablation or left atrial appendage closure were classified into the VCD (n = 304) and the MC (n = 499) group, based on the methods used for haemostasis at the venous access site. Foley catheter was used for bladder-emptying in all MC cases and 15 VCD patients. At one site, VCD group patients with experience of MC in prior ablations were asked to describe their overall satisfaction level after comparing the past experience with the present. Haemostasis was achieved effectively in both populations. No VCD cases required >2 h bed rest, whereas 7 (1.4%) patients in the MC group needed prolonged immobilization (P = 0.04). Significantly higher incidence of access-site haematoma (P = 0.004) and urinary complications (P < 0.05) were observed in the MC group. Majority of VCD patients (68%) with prior experience of MC for haemostasis expressed satisfaction over the early ambulation and ability to void urine without bladder catheterization. CONCLUSION: Vascular closure devices provided effective haemostasis, while reducing the access-site complications, ambulation time, and urinary complications. Published on behalf of the European Society of Cardiology. All rights reserved.
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