Plug- Versus Sutured-Based Vascular Closure Devices for Large Bore Arterial Access: A Systematic Review and Meta-Analysis

Vascular complications after cardiovascular interventions requiring large-bore arterial access remain frequent and devastating. Whether plug-based vascular closure devices (P-VCD) or sutured-based vascular closure device (S-VCD) are superior in terms of safety and efficacy remains unclear. Aim of our systematic review and meta-analysis was to compare P-VCD with S-VCD. We systematically screened 3 major databases for 2-arm studies comparing P-VCD with S-VCD. Primary endpoint was device success. Secondary endpoints included in-hospital all-cause mortality, major and minor bleeding, major and minor vascular complications, unplanned vascular surgery, endovascular treatment and hospital stay. For categorical variables, we used risk ratios (RRs) with 95% confidence intervals (CIs) and for continuous variables, mean differences or standardized mean differences. A total of 23 studies and 7,584 patients were included in our analysis. No significant differences were observed in device success (RR: 0.98, 95% CI: 0.96 to 1.00, I² = 62%), all-cause mortality (RR: 0.60, 95% CI: 0.19 to 1.87), major bleedings (RR: 0.68, 95% CI: 0.44 to 1.07), minor bleedings (RR: 0.83, 95% CI: 0.54 to 1.27), major vascular complications (RR: 0.89, 95% CI: 0.56 to 1.42), minor vascular complication (RR: 1.22, 95% CI: 0.82 to 1.83), endovascular treatment (RR: 1.35, 95% CI: 0.79 to 2.29) or unplanned vascular surgery (RR: 1.12, 95% CI: 0.68 to 1.87). However, hospital length of stay was reduced by 0.2 ± 0.13 days in patients treated with P-VCD. In conclusion, our systematic review and meta-analysis, the largest to date, demonstrated no significant differences between P-VCD and S-VCD, regarding safety or efficacy outcomes, except for a shorter hospital stay associated P-VCD. Further studies are required to validate these results.