Reducing vascular complications in post-percutaneous coronary intervention patients : angio-seal versus manual compression

Abstract

Ischemic heart disease is the primary cause of death globally, with percutaneous coronary interventions (PCI) being the leading treatment available. It is crucial that this procedure is as safe as possible. Access site haemostasis post-PCI is important since bleeding may cause serious complications. Manual compression (MC) is the traditional way of achieving haemostasis; however the benefit of this is questionable and thus vascular closure devices were developed. The PICO question was formulated, this is; ‘Is an Angio-seal closure device (Intervention) more effective in reducing vascular complications (Outcome) compared to applying MC (Comparison), in patients undergoing PCI (Population)?’ The inclusion and exclusion criteria were established. Articles published between 2004 and 2015 and those written in English were included. Studies needed to focus on coronary interventions, specifically PCI. If studies also incorporated diagnostic procedures, the results had to be presented separately for these to be included. Studies which investigated Angio-seal vs. MC were included, along with those with multiple VCDs with the Angio-seal results presented independently. Outcomes of the studies had to include vascular complications (VCs). Studies with participants under the age of eighteen were ex-cluded from the review. Four databases were searched, yielding a total of 159 relevant studies. Duplicates were removed and then further refined to 6 key studies, including one meta-analysis, two RCTs and three N-RCTs. Critical appraisal of these studies was done using the applicable CASP tools. The strongest evidence revealed that Angio-seal vs. MC resulted in similar VCs rates post- PCI, whilst two studies showed a potential benefit in reducing VCs by using the Angio-seal. Important recommendations were highlighted, including; conducting stronger studies (RCTs), introducing a protocol locally and making it mandatory that all operators are trained on Angio-seal deployment. In conclusion, this review suggests that AS and MC are at least as safe as each other, however more research is required to demonstrate a benefit by using Angio-seal in relation to reducing VCs.