Comparison of Suture-Based and Collagen-Based Vascular Closure Devices for Large Bore Arteriotomies—A Meta-Analysis of Bleeding and Vascular Outcomes

Abstract

Background: Large bore access procedures rely on vascular closure devices to minimize access site complications. Suture-based vascular closure devices (S-VCD) such as ProGlide and ProStar XL have been readily used, but recently, newer generation collagen-based vascular closure devices (C-VCD) such as MANTA have been introduced. Data on comparisons of these devices are limited. Methods: PubMed, Scopus and Cochrane were searched for articles on vascular closure devices using keywords, (“Vascular closure devices” OR “MANTA” OR “ProStar XL” OR “ProGlide”) AND (“outcomes”) that resulted in a total of 875 studies. Studies were included if bleeding or vascular complications as defined by Valve Academic Research Consortium-2 were compared between the two types of VCDs. The event level data were pooled across trials to calculate the Odds Ratio (OR) with 95% CI, and analysis was done with Review Manager 5.4 using random effects model. Results: Pooled analyses from these nine studies resulted in a total of 3410 patients, out of which 2855 were available for analysis. A total of 1229 received C-VCD and 1626 received S- VCD. Among the patients who received C-VCD, the bleeding complications (major and minor) were similar to patients who received S-VCD ((OR: 0.70 (0.35–1.39), p = 0.31, I2 = 55%), OR: 0.92 (0.53–1.61), p = 0.77, I2 = 65%)). The vascular complications (major and minor) in patients who received C-VCD were also similar to patients who received S-VCD ((OR: 1.01 (0.48–2.12), p = 0.98, I2 = 52%), (OR: 0.90 (0.62–1.30), p = 0.56, I2 = 35%)). Conclusions: Bleeding and vascular complications after large bore arteriotomy closure with collagen-based vascular closure devices are similar to suture-based vascular closure devices.

Keywords

• vascular closure devices
• suture
• collagen
• transcatheter aortic valve replacement
• bleeding outcomes
• vascular outcomes