Author + information
- Received March 4, 1994
- Revision received October 26, 1994
- Accepted February 8, 1995
- Published online June 1, 1995.
- William G. Kussmaul III, MD, FACC**,a,
- Maurice Buchbinder, MD, FACC*,
- Patrick L. Whitlow, MD, FACC†,
- Umit T. Aker, MD, FACC‡,
- Richard R. Heuser, MD, FACC§,
- Spencer B. King, MD, FACC║,
- Kenneth M. Kent, MD, FACC¶,
- Martin B. Leon, MD, FACC¶ and
- Daniel M. Kolansky, MD, FACC#
- ↵**Address for correspondence:Dr. William G. Kussmaul III, Associate Director, Cardiac Catheterization Laboratory, Hahnemann Hospital, Mailstop 119, Broad and Vine Streets, Philadelphia, Pennsylvania 19102.
- Joseph G. Sandza Jr., MD, FACC
Objectives. This study was performed to test the safety and efficacy of a novel bioabsorbable hemostatic puncture closure device deployed through an arterial sheath.
Background. Cardiac catheterization procedures are associated with a risk of complications at the arterial access site. Increasing numbers of interventional procedures requiring large sheaths or intense anticoagulation underline the need for occure, rapid methods of obtaining hemostasis at the time of sheath removal.
Methods. We conducted a randomized, multicenter trial in 435 patients undergoing cardiac catheterization or angioplasty at eight participating centers. In 218 patients, hemostasis was achieved using the device (group 1); 217 patients were assigned to the manual pressure control group (group II).
Results. There were no significant differences in baseline characteristics. Time to hemostasis was considerably shorter in group I (2.5 ± 15.2 vs 15.3 ± 11.7 min [mean ± SD], p < 0.0001). The deployment success rate for the device was 96%, and 76% of group I patients experienced immediate (within 1 min) hemostasis. Complication rates were lower in group I for bleeding, hematoma and occurrence of any complication. There was no difference in the small incidence of pseudoaneurysm formation. There was no change in either group in the ankle/brachial systolic blood pressure index. Ultrasound follow-up studies 60 days after device deployment revealed complete absorption of the device in all cases. Subgroup analysis revealed particular benefit in patients undergoing interventional procedures. The administration of heparin was associated with a significantly higher complication rate in the manual pressure control group, whereas heparin had no effect on hemostasis time or complication rates in the device group.
Conclusions. This sheath-deployed, bioabsorbable device provides a safe and effective means of obtaining rapid arterial hemostasis after cardiac catheterization procedures. It appears to be particularly useful in those patients most at risk for access site complications.
This study was supported by grants from the Kensey Nash Corporation, Exton, Pennsylvania.
- Received March 4, 1994.
- Revision received October 26, 1994.
- Accepted February 8, 1995.
- American College of Cardiology