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Reduced Rate and Cost Of Complications

7/16/2019 -  

​A Cost-Minimization Analysis of the Angio-Seal Vascular Closure Device Following Percutaneous Coronary Intervention

Resnic FS, et al. A cost-minimization analysis of the Angio-Seal vascular closure device following percutaneous coronary intervention (PCI). Am J Cardiol. 2007;99(6):766-70.


Objective: Explore the health economic implications of routinely using the Angio-Seal vascular closure device after PCI

  • 3.943 patients who underwent PCI January 2002 through December 2004 were followed prospectively through time of discharge. Full cost accounting and hospital records were available for analysis

  • A model was constructed to compare the expected cost to the hospital of a patient receiving the Angio-Seal device after PCI with that of a patient receiving mechanical compression


  • The hospital realized a net cost savings of $44 for each study patient who received an Angio-Seal device over those treated with mechanical compression

  • The economic benefit of the Angio-Seal device reflected the higher rate of access site bleeding and pseudoaneurysm in the mechanical compression group

  • Cost of vascular complications can ranged from $1.399 for a hematoma to $6.698 for a retroperitoneal hemorrhage.

  • A sensitivity analysis found that the cost of compression would have to drop below $66 to become more cost-effective than the Angio-Seal device


  • Cost-minimization continues to drive many decisions in healthcare institutions. This retrospective review demonstrated the economic benefit realized when selecting to treat PCI patients with the Angio-Seal vascular closure device versus mechanical compression.

Network Meta-analysis of Randomised Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.

Jun Jiang et al. Network Meta-analysis of Randomised Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis. Sci Rep.; 5:13761. 2015.


Objective: Network meta-analysis comparing the safety of different VCDs.

  • 40 RCTs with 16.868 patients

  • Comparison of different VCDs vs MC with patients undergoing diagnostic and/or interventional femoral procedures

  • Traditional meta-analysis: no significant difference in the rate of Combined Adverse Vascular Events (CAVEs) between all the VCDs and manual compression (MC)



1. Direct meta-analysis:

  • Traditional meta-analysis: risk for CAVE is similar between VCDs and MC

  • Subgroup analysis: similar results, but FemoSeal showed significantly reduced risk of CAVE

  • Haematoma risk: significantly lower with VCDs vs MC (RR: 0.80, CI: 0.71-0.90)

  • Design improvements of VCDs & increased user experience -> decreases risk of CAVE

​​Vascular closure devices

N° of studies

​Total Patients 

​M-H, random


​Test for overal effect

​RR (95% CI)


​Z value 

​P value




​0.69 [0.46, 1.03]







1.10 [0.75, 1.61]







1.45 [0.55, 3.84]







1.27 [0.48, 3.37]







0.75 [0.60, 0.94]







1.00 [0.65, 1.52]







0.63 [0.29, 1.37]




*Statistically significant.

2. Network analysis on CAVE:

  • Angio-Seal – reduced risk of CAVE vs MC (RR: 0.67, CI: 0.46–0.98)

  • Other VCDs: similar risk for CAVE vs MC. No difference in risk for CAVE between different VCDs.

  • The use of VCDs significantly decreased the risk of haematomas

  • The newly developed VCDs significantly reduced the rate of CAVE

  • FemoSeal also significantly reduced the risk of CAVE. Newer VCDs with advanced design might improve the safety of VCDs

  • Angio-Seal, which might be the best VCD among all included VCDs, reduced the rate of both CAVE and haematomas vs MC