Ultrasound Guided Versus Conventional Closure Device Deployment Following Transfemoral Endovascular Procedures: A Systematic Review and Meta-analysis

Objective: Femoral access site complications influence short term survival and outcomes in patients undergoing endovascular procedures. While ultrasound guided puncture is a reliable method to reduce such complications, ultrasound guidance is rarely used for closure device deployment. Data Sources: Web of Science, PubMed, and the Cochrane Library. Review Methods: A systematic literature search was conducted to assess the safety and efficacy of ultrasound guided vascular closure device deployment compared with vascular closure device deployment without ultrasound guidance, referred to as conventional closure. All studies reporting on ultrasound guided closure in transfemoral arterial interventions were eligible, and those directly comparing ultrasound guided with conventional closure were included in the meta-analysis. Results: Overall, 2 738 patients receiving ultrasound guided closure were included: 1 025 for introducer sheaths measuring 12 F or larger and 1 713 for introducer sheaths smaller than 12 F. The incidence of access complications was 5.7% (range 0.8 – 21.6%) for large sheath procedures and 2.6% (range 0.9 – 4.7%) for small sheath procedures. The meta-analysis, which included 2 339 patients who received ultrasound guided closure and 1 175 who underwent conventional closure, showed that ultrasound guided closure was associated with reduced access site complications compared with conventional closure (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.37 – 0.65; p < .001). This was consistently seen both for small sheath (OR 0.45, 95% CI 0.28 – 0.75; p = .002) and large sheath procedures (OR 0.50, 95% CI 0.37 – 0.71; p < .001), but with a low certainty of evidence in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis. Conclusion: Ultrasound guided vessel closure of the femoral artery appeared to be associated with a lower rate of overall access site complications compared with conventional closure techniques. Therefore, ultrasound guided closure might offer the potential to increase procedural and patient safety in percutaneous arterial access.