Plug- vs suture-based devices: Which is better for large-bore arterial access closure?

A systematic review and meta-analysis that included 23 studies shows similar safety and efficacy profiles between plug-based vascular closure devices (P-VCDs) and suture-based VCDs (S-VCDs) in large-bore arterial access closure, but the former appears to have an edge over the latter in terms of bleeding events and hospital stay in some of the studies.

S-VCDs have been the primary choice for percutaneous access site closure in large-bore access procedures for over a decade. On the other hand, P-VCDs have been introduced most recently as an alternative VCD. [JACC Cardiovasc Interv 2013;6:643-653; EuroIntervention 2016;12:896-900]

Primary outcome

The analysis about device success involved data from 14 trials (n=4,377). Of the 2,738 patients treated with an S-VCD, device implantation was successful in 2,562 individuals. In the P-VCD group (n=1,639), 1,558 had successful device implantation. [Am J Cardiol 2025:252:56-66]

A comparison between groups revealed no significant difference in terms of device success (risk ratio [RR], 0.98), but there was a trend towards increased device success in the P-VCD group. According to the investigators, this trend may have been driven by nonrandomized studies, where the finding was borderline in favour of P-VCDs (RR, 0.98).

Secondary outcomes

There were no significant between-group differences in in-hospital all-cause mortality, but there was a numerical trend favouring P-VCDs over S-VCDs (seven studies; RR, 0.60).

There were also no between-group differences in the analysis of bleeding events (15 studies; RR, 0.80), as well as in separate analyses of life-threatening or major, life-threatening, major, and minor bleeding (RRs, 0.68, 1.13, 0.76, and 0.83, respectively).

P-VCDs and S-VCDs were also comparable in terms of total, major, and minor vascular complications (RRs, 1.08, 0.89, and 1.22, respectively); pseudoaneurysm (RR, 0.95); unplanned endovascular treatment of vascular access, covered stent implantation, and unplanned vascular surgery (RRs, 1.35, 1.33, and 1.12); and need of blood transfusion (RR, 0.81).

In nonrandomized trials however, P-VCDs were associated with significantly lower rates of all bleedings (RR, 0.71) and life-threatening or major bleedings (RR, 0.58). This was not the case in randomized studies (RR, 1.23 [all bleedings] and RR, 1.25 [life-threatening or major bleedings]).

P-VCDs may have an edge

Of note, P-VCDs were associated with a significantly shorter hospital stay than S-VCDs (SMD, -0.20 days). “This finding, while initially unexpected, may be explained by several clinically relevant factors,” the researchers said.

P-VCDs may enable earlier haemostasis and faster patient mobilization, leading to faster recovery timelines, and their technical simplicity could reduce post-procedural monitoring requirements, they noted. “[Moreover,] the observed reduction in hospitalization duration may reflect preferential adoption of P-VCDs in institutions prioritizing operational efficiency, where even modest time savings per patient can yield substantial workflow benefits.”

According to the investigators, the shorter hospital stay has potential implications for healthcare efficiency and resource utilization. The potential for earlier discharge may be particularly valuable for facilities with high procedural volumes or those implementing rapid discharge protocols for select patients.

Nonetheless, they called for prospective studies to validate the results and further interpret the potential advantages of specific closure device strategies.