• Tomoya Okamoto, Masashi Kotsugi, Hiromitsu Sasaki, Ai Okamoto, Kenta Nakase, Yudai Morisaki, Ryosuke Maeoka, Shohei Yokoyama, and Ichiro Nakagawa.
• Department of Neurosurgery, Nara Medical University, Nara, Japan.
• World Neurosurg. 2024 Aug 1; 188: e305e311e305-e311.

ObjectivePuncture-site complications in interventional radiology sometimes cause severe conditions. Vascular closure devices play an important role in preventing puncture-site complications. Vascular closure devices are divided into 2 types, the directly suturing or clipping type (active approximators) and adherent sealant types (passive approximators). However, which types of vascular closure device are the safest and most effective for achieving hemostasis remains unclear. We analyzed the efficacy of each type of vascular closure device and risk factors for puncture-site complications.MethodsThis study investigated 327 consecutive cases of neuroendovascular surgery using a transfemoral procedure during a 2-year study period. Passive approximators (Angioseal [St Jude Medical, Saint Paul, MN] and Exoseal [Cordis Corporation, Miami, FL]) were mainly used in the first half and active approximators (Perclose [Abbot Vascular, Santa Clara, CA]) in the second. We compared groups and estimated risk factors for puncture-site complications.ResultsAll procedures were successful. Comparing groups with and without puncture-site complications, use of passive approximators and ≥3 antithrombotic medications tended to be more frequent and distance from skin to femoral artery and body mass index tended to be lower in the group with complications without significance. The cutoff for femoral artery depth calculated from a receiver operating characteristic curve was 16.43 mm. Multivariate analysis revealed ≥3 antithrombotic medications (P = 0.002, OR 15.29, 95% CI 2.76-85.76) and passive approximator use in patients with femoral artery depth <16.43 mm (P < 0.001, OR 17.08, 95% CI 2.95-57.80) were significantly higher in the group with puncture-site complications.ConclusionsPassive approximator use in patients with shallow femoral artery depth increases puncture-site complications in neuroendovascular treatment.Copyright © 2024 Elsevier Inc. All rights reserved.

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