Effectiveness of femoral arterial closure devices compared to traditional compression methods following femoral sheath removal: A Systematic Review.

Abstract

Review Questions/Objectives The systematic review objective is to synthesise the best available research evidence related to the effectiveness of femoral arterial closure devices as compared to traditional compression methods post femoral sheath removal in the cardiovascular patient. The specific review question to be addressed is: • What effects do femoral arterial closure devices, as compared to traditional compression methods, have on outcomes post femoral sheath removal in the cardiovascular patient? Inclusion Criteria Types of participants This review will consider studies that included all types of cardiovascular adult patients (18+ years old) with post femoral sheath removal following endovascular procedures regardless of previous treatments. The femoral artery is preferable access site due to the larger diameter of the artery compared to the radial or brachial arteries. Due to the larger diameter of the femoral artery, time to hemostatis and complications are significantly different than that of the brachial or radial arteries.For accurate comparison, patients undergoing procedures using radial or brachial access will not be included. Types of interventions The interventions of interest are arterial closure devices and traditional compression methods used following femoral arterial sheath removal. Studies that compare arterial closure devices and compression methods post endovascular procedure will be included in this review. Similarly, studies that compare various compression methods post endovascular procedure will be included in this review. Studies that compare radial or brachial access to femoral access and hemostasis will not be included in this review to allow for accurate comparison. Femoral access has significantly differing times to hemostatis and complication rates than radial or brachial access. Types of outcome measures The primary outcome of interest is the difference in effectiveness of femoral arterial closure devices and traditional compression methods on patient outcomes. Studies meeting criteria for participants and intervention which include outcomes related to bleeding risks and vascular complications, such as hematoma, bleeding at the site, retroperitoneal bleeding, pseudoanuerysm, and AV-fistula creation will be considered for inclusion in this review. In addition, studies describing attainment of hemostasis following femoral sheath removal will be considered.