A Comparison of Figure-of-8-Suture vs Manual Compression for Venous
Access Closure after Cardiac Procedures: An Updated Meta-Analysis.
Abstract
Background Manual compression (MC) is the current standard to achieve
post-procedural hemostasis in patients who need venous vascular access
closure after cardiovascular procedures. Figure-of-8 (F8) suture for
venous access closure has been reported to be a safe and efficacious
alternative to MC. Methods A systematic search was done using PubMed,
Google Scholar, EMBASE, SCOPUS and ClinicalTrials.gov without language
restriction up until April 15, 2020 for studies comparing F8 suture vs
MC. Risk ratio (RR) and mean difference (MD) with 95% confidence
interval (CI) were calculated using a random effects model. Results Time
to achieve hemostasis was significantly reduced in the F8 arm [MD
-21.04 mins (95% CI: -35.66 to -6.42; p=.005)]. Access site bleeding
was significantly lower in the F8 group [RR 0.35 (95% CI: 0.18 to
0.66; p=0.001)] along with a lower incidence of hematoma formation
[RR 0.42 (95% CI 0.26 to 0.67; p=0.0003)]. There was no significant
difference in rates of fistula or pseudoaneurysm formation between the
two groups. Overall access site complications were lower in the F8 arm
[RR 0.38 (95% CI: 0.26 to 0.55; p<0.00001)] and the
effect was more pronounced for sheaths ≥10 Fr [RR 0.33 (95% CI: 0.18
to 0.60; p=0.0003)]. There was lower post-procedural protamine use in
the F8 group [RR 0.07 (95% CI:0.01 to 0.36; p=0.001)]. Conclusion
For large-bore venous access closure, the F8 suture results in a
shortened time to achieve hemostasis along with a lower overall risk of
access site complications and post-procedural protamine use.