{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:57:42Z","timestamp":1785387462995,"version":"3.55.0"},"reference-count":11,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ramsay Sante pour l\u2019Enseignement et la Recherche"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Access-site complications (ASCs) remain clinically relevant after peripheral endovascular procedures, particularly with large femoral sheaths and complex anatomy. While randomized coronary trials show non-inferiority of vascular closure devices (VCDs) versus manual compression (MC), real-world data in peripheral interventions performed under systematic ultrasound-guided access are limited. Materials and Methods: This retrospective single-center cohort included consecutive peripheral arterial revascularizations (2010\u20132023) performed via common femoral access under real-time ultrasound guidance. Hemostasis was achieved using MC or VCDs, categorized as collagen plug-based, suture-mediated, or clip-based systems. The primary endpoint was 30-day ASCs, defined as hematoma requiring management, pseudoaneurysm, bleeding requiring transfusion, access-site thrombosis\/occlusion, arteriovenous fistula, or infection. The secondary endpoint was VCD failure, defined as unsuccessful hemostasis requiring adjunctive measures. Multivariable logistic regression adjusted for prespecified anatomical and procedural covariates, including sheath size &gt; 6 Fr and puncture-site calcification. Results: Among 231 procedures, VCDs were used in 139 (60.2%) and MC in 92 (39.8%). ASC occurred in 28 cases (12.1%), with higher rates in the MC group compared with VCDs (18.5% vs. 9\u201314% across device types; p = 0.044). In adjusted analyses, MC (vs any VCD) (odds ratio [OR] 2.41, 95% confidence interval [CI] 1.06\u20135.47; p = 0.035), sheath size &gt; 6 Fr, and puncture-site calcification were independently associated with ASCs. VCD failure occurred in 5 cases (3.6%) and was not observed with collagen plug-based devices. Conclusions: In this ultrasound-guided real-world peripheral cohort, VCD use was associated with lower 30-day ASC rates and low device failure rates compared with MC. Given the retrospective and non-randomized design, these findings should be considered hypothesis-generating and support individualized, imaging-guided strategies for femoral closure in peripheral interventions.<\/jats:p>","DOI":"10.3390\/medicina62010028","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:05:22Z","timestamp":1766498722000},"page":"28","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound-Guided Femoral Hemostasis in Peripheral Angioplasty: Real-World Outcomes with Vascular Closure Devices Versus Manual Compression"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-0389","authenticated-orcid":false,"given":"Ioannis","family":"Skalidis","sequence":"first","affiliation":[{"name":"Department of Cardiology, HFR Fribourg\u2014Cantonal Hospital, University of Fribourg, 1700 Fribourg, Switzerland"},{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livio","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariama","family":"Akodad","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9502-2808","authenticated-orcid":false,"given":"Youcef","family":"Lounes","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6593-4793","authenticated-orcid":false,"given":"Hakim","family":"Benamer","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Honton","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Sauguet","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neila","family":"Sayah","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Laforgia","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Amabile","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-9185","authenticated-orcid":false,"given":"Thomas","family":"Hovasse","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8960-7006","authenticated-orcid":false,"given":"Philippe","family":"Garot","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3873-1652","authenticated-orcid":false,"given":"Antoinette","family":"Neylon","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2127-5778","authenticated-orcid":false,"given":"Francesca","family":"Sanguineti","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7431-6305","authenticated-orcid":false,"given":"Stephane","family":"Champagne","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4810-3159","authenticated-orcid":false,"given":"Thierry","family":"Unterseeh","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.ahj.2009.12.027","article-title":"Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty","volume":"159","author":"Biancari","year":"2010","journal-title":"Am. Heart J."},{"key":"ref_2","first-page":"1200","article-title":"Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: A meta-analysis","volume":"44","author":"Nikolsky","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1161\/CIRCINTERVENTIONS.114.001306","article-title":"Access site complications after peripheral vascular interventions: Incidence, predictors, and outcomes","volume":"7","author":"Ortiz","year":"2014","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.jvs.2022.03.890","article-title":"Access site complications are uncommon with vascular closure devices or manual compression after lower extremity revascularization","volume":"76","author":"Cheng","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1177\/15266028211025044","article-title":"Access Site Complications of Peripheral Endovascular Procedures: A Large, Prospective Registry on Predictors and Consequences","volume":"28","author":"Cacuci","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.jvs.2020.08.133","article-title":"Complication rates associated with antegrade use of vascular closure devices: A systematic review and pooled analysis","volume":"73","author":"Kennedy","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1056\/NEJMoa051303","article-title":"Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery","volume":"354","author":"Schillinger","year":"2006","journal-title":"N. Engl. J. 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Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1001\/jamacardio.2022.3399","article-title":"Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac Procedures: The UNIVERSAL Randomized Clinical Trial","volume":"7","author":"Jolly","year":"2022","journal-title":"JAMA Cardiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/28\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:37:06Z","timestamp":1766500626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/28"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["medicina62010028"],"URL":"https:\/\/doi.org\/10.3390\/medicina62010028","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]}}}