Editorial Comment

Arterial Sealing: We KeepPlugging Away

Joel K. Kahn, MD

William Beaumont Hospital,Royal Oak, Michigan

The basics are the basics because they are basic. Gaining controlof arterial access sites is a basic principle of all invasive cardiologyprocedures. On the one hand, the most elegant stent or atherectomyprocedure can turn to disaster by inadequate hemostasis. On theother, the changing economic pressures in medicine argue forimproved bed efficiency and shortened hospital stays with im-proved quality outcomes. Effective arterial sealing devices have thepromise of improving both aspects of the hemostatic problem.

Silber and associates contribute another piece of the puzzle in theevaluation of the role of routine collagen plugging after coronaryintervention [1]. They successfully demonstrated that collagenplugging results in shorter times to hemostasis after sheath removalwhen compared to manual compression at the same interval afterarterial puncture. Medium and large hematomas were infrequent inboth groups. Patients in the collagen plug group were discharged a

day earlier than the other group, and although costs were not lookedat in this smaller study, they probably were lower in the collagengroup.

On a personal note, I was skeptical of collagen plugs when theywere first introduced, but I forced myself to master the techniqueand I am rather fond of the procedure. I can routinely discharge mypatients having diagnostic procedures a few hours earlier, and it is awin-win for the patient and the hospital. What I need to influencemy usage patterns in a significant way is a large and contemporarytrial comparing immediate sheath removal and same day dischargeof uncomplicated intervention patients treated with collagen plugsto standard manual compression and overnight observation. We areembarking on such a trial at William Beaumont Hospital, andothers are underway. It is possible that improvements in competi-tive techniques such as transradial interventions may make thepoint moot. In the meantime, we will keep plugging away atattempts to define the best method to deal with arterial sealing.

REFERENCE

1. Silber S, Bjorvik A, Muhling H, Rosch A: Usefulness of collagenplugging with VasoSealt after PTCA as compared to manualcompression with identical sheath dwell times. Cathet CardiovascDiagn 43:421–427, 1998.

Catheterization and Cardiovascular Diagnosis 43:428 (1998)

r 1998 Wiley-Liss, Inc.