***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective Rapid and effective hemostasis at femoral puncture sites minimizes both the hospital stay and patient discomfort . Therefore , a variety of arterial closure devices have been developed to facilitate the closure of femoral arteriotomy . The objective of this prospect i ve study was to compare the efficacy of two different closure devices ; a collagen plug device ( Angio-Seal ) and a suture-mediated closure device ( the Closer S ) . Material s and Methods From March 28 , 2003 to August 31 , 2004 , we conducted a prospect i ve study in which 1,676 cases of 1,180 patients were treated with two different types of closure device .  Angio-Seal was used in 961 cases and the Closer S in 715 cases . The efficacy of the closure devices was assessed , as well as complications occurring at the puncture sites . Results Successful immediate hemostasis was achieved in 95.2 % of the cases treated with Angio-Seal , and in 89.5 % of the cases treated with the Closer S ( p < 0.05 ) . The rates of minor and major complications occurring between the two groups were not significantly different . In the Closer S group , we observed four major complications ( 0.6 % ) , that consisted of one massive retroperitoneal hemorrhage ( surgically explored ) and three pseudoaneurysms . In the Angio-Seal group , we observed three major complications ( 0.3 % ) that consisted of one femoral artery occlusion , one case of infection treated with intravenous antibiotics and one pseudoaneurysm . Conclusion The use of Angio-Seal was found to be more effective than that of the Closer S with regard to the immediate hemostasis of the femoral puncture sites . However , we detected no significant differences in the rate at which complications occurred OBJECTIVES The aim was to investigate whether the fascia suture technique ( FST ) can reduce access closure time and procedural costs compared with the Prostar technique ( Prostar ) in patients undergoing endovascular aortic repair and to evaluate the short- and mid-term outcomes of both techniques . METHODS In this two center trial , 100 patients were r and omized to access closure by either FST or Prostar between June 2006 and December 2009 . The primary endpoint was access closure time . Secondary outcome measures included access related costs and evaluation of the short- and mid-term complications . Evaluation was performed peri- and post-operatively , at discharge , at 30 days and at 6 months follow up . RESULTS The median access closure time was 12.4 minutes for FST and 19.9 minutes for Prostar ( p < .001 ) . Prostar required a 54 % greater procedure time than FST , mean ratio 1.54 ( 95 % CI 1.25 - 1.90 , p < .001 ) according to regression analysis . Adjusted for operator experience the mean ratio was 1.30 ( 95 % CI 1.09 - 1.55 , p = .005 ) and for patient body mass index 1.59 ( 95 % CI 1.28 - 1.96 , p < .001 ) . The technical failure rate for operators at proficiency level was 5 % ( 2/40 ) compared with 28 % ( 17/59 ) for those at the basic level ( p = .003 ) . The proficiency level group had a technical failure rate of 4 % ( 1/26 ) for FST and 7 % ( 1/14 ) for Prostar , p = 1.00 , while corresponding rates for the basic level group were 27 % ( 6/22 ) for FST and 30 % ( 11/37 ) for Prostar ( p = .84 ) . There was a significant difference in cost in favor of FST , with a median difference of € 800 ( 95 % CI 710 - 927 , p < .001 ) . CONCLUSIONS In aortic endovascular repair FST is a faster and cheaper technique than the Prostar technique This study investigated the usefulness of collagen plugging with VasoSeal in patients after PTCA compared to a control group having identical sheath dwell times and therefore comparable levels of anticoagulation . A total of 150 patients were enrolled in this prospect i ve and r and omized study . Sheaths were pulled at exactly 5 h after arterial puncture . Time to hemostasis and local complications were determined . There were no statistical differences in baseline characteristics . The mean time to hemostasis in the collagen group was significantly shorter ( 3 + /- 3 min ) than that of the control group ( 17.4 + /- 7 min ) . At 24 h , 23 % of the collagen group patients had a small , 1 % a medium and 4 % a large hematoma . In the control group , 32 % had a small , 4 % a medium sized , but no patient a large hematoma . After collagen , one patient developed a pseudoaneurysm needing vascular surgery . In the control group , no major complication occurred . Compared to patients with manual compression at an identical sheath dwell time and an identical level of anticoagulation , there was a significant reduction in time to hemostasis but no statistical difference regarding local complications . Although the incidence of medium or large hematoma was low , the trend towards a decreased risk of smaller hematomas seemed to be counterbalanced by an increased risk of larger hematomas Background : The StarClose ® Vascular Closure System ( Abbott Vascular , Redwood City , CA ) features a nitinol clip that is design ed to achieve closure of the femoral arteriotomy access site . The CLIP Study was performed to assess the safety and efficacy of StarClose when compared with st and ard manual compression following 5–6 French diagnostic or interventional percutaneous procedures . A sub study of this trial was design ed to assess the utility of duplex ultrasonography to assess patency of the femoral artery and to determine access site complications ( pseudoaneurysm , arteriovenous fistula , hematoma , deep vein thrombosis ) in a multicenter prospect i ve trial . This is the report of the duplex ultrasound ( DUS ) sub study of the CLIP trial . Methods : A total of 17 U.S. sites enrolled 596 subjects with 483 subjects r and omized at a 2:1 ratio to  receive StarClose or manual compression of the arteriotomy after a percutaneous procedure . The study included roll‐in ( n = 113 ) , diagnostic ( n = 208 ) , and interventional ( n = 275 ) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis . A sub study of the CLIP interventional arm evaluated DUS images of the closure site at five study sites , targeting 100 subjects at day 30 following hemostasis . The DUS protocol was devised and implemented by an independent vascular ultrasound core laboratory with extensive experience in vascular device trials . DUS inguinal region from 6 cm proximal to 6 cm distal to the arteriotomy puncture was performed . A qualitative examination was performed to determine the presence of iatrogenic vascular injuries : hematoma , pseudoaneurysm ( PSA ) , arteriovenous fistula ( AVF ) , and arterial/venous thrombosis or stenosis using 2‐dimensional gray scale , color , and focused Doppler images . Results : DUS of 96 subjects r and omized to StarClose ( n = 71 ) and compression ( n = 25 ) were performed and evaluated . There was no evidence of hematoma , PSA , or AVF observed in the StarClose group . No StarClose subjects in the sub study had a PSA or AVF . All patients in the sub study demonstrated patency of the access site artery and vein without thrombosis or stenosis . Finally , in the entire study cohort , no clinical ly‐driven DUS studies demonstrated iatrogenic vascular injury or vessel thrombosis in the StarClose treated patients . Conclusion : DUS , a safe and reliable method for determining the safety and efficacy of access site closure devices , is a reliable , safe , inexpensive and accurate method of assessing vascular access site complications in multicenter trials . In this sub study of the CLIP study , DUS found no statistical difference in access site complications between the StarClose and manual compression groups . Both groups maintained vessel patency without stenosis , thrombosis , hematoma , pseudoaneurysm , or AV fistula . © 2006 Wiley‐Liss , OBJECTIVE The first multicenter r and omized controlled trial was design ed and conducted to assess the safety and effectiveness of  totally percutaneous endovascular aortic aneurysm repair ( PEVAR )  with use of a 21F endovascular stent graft system and either an 8 F or 10 F suture-mediated closure system ( the PEVAR trial , NCT01070069 ) . A noninferiority trial design was chosen to compare percutaneous access with st and ard open femoral exposure . METHODS Between 2010 and 2012 , 20 U.S. institutions participated in a prospect i ve , Food and Drug Administration-approved r and omized trial to evaluate percutaneous femoral artery access and closure by a " preclose " technique in conjunction with endovascular abdominal aortic aneurysm repair . A total of 151 patients were allocated by a 2:1 design to percutaneous access/closure ( n = 101 ) or open femoral exposure ( n = 50 [ FE ] ) . PEVAR procedures were performed with either the 8 F Perclose ProGlide ( n = 50 [ PG ] ) or the 10 F Prostar XL ( n = 51 [ PS ] ) closure devices . All endovascular abdominal aortic aneurysm repair procedures were performed with the Endologix 21 F profile ( outer diameter ) sheath-based system . Patients were screened by computed tomography with three-dimensional reconstruction and independent physician review for anatomic suitability and adequate femoral artery anatomy for percutaneous access . The primary trial end point ( treatment success ) was defined as procedural technical success and absence of major adverse events and vascular complications at 30 days . An independent access closure sub study evaluated major access-related complications . Clinical utility and procedural outcomes , ankle-brachial index , blood laboratory analyses , and quality of life were also evaluated with continuing follow-up to 6 months . RESULTS Baseline characteristics were similar among groups . Procedural technical success was 94 % ( PG ) , 88 % ( PS ) , and 98 % ( FE ) . One-month primary treatment success was 88 % ( PG ) , 78 % ( PS ) , and 78 % ( FE ) , demonstrating noninferiority vs FE for PG ( P = .004 ) but not for PS ( P = .102 ) . Failure rates in the access closure sub study analyses demonstrated noninferiority of PG ( 6 % ; P = .005 ) , but not of PS ( 12 % ; P = .100 ) , vs FE ( 10 % ) . Compared with FE , PG and PS yielded significantly shorter times to hemostasis and procedure completion and favorable trends in blood loss , groin pain , and overall quality of life . Initial noninferiority test results persist to 6 months , and no aneurysm rupture , conversion to open repair , device migration , or stent graft occlusion occurred . CONCLUSIONS Among trained operators , PEVAR with an adjunctive preclose technique using the ProGlide closure device is safe and effective , with minimal access-related complications , and it is noninferior to st and ard open femoral exposure . Training , experience , and careful application of the preclose technique are of paramount importance in ensuring successful , sustainable outcomes Objectives : To compare Angio‐Seal ( AS ) and StarClose ( SC ) and manual compression ( MC ) on efficacy of hemostasis , complication rate , safety of early mobilization , and patient comfort . Background : Closure of the femoral artery after cardiac catheterization can be obtained through different methods . Today , physicians can choose from a number of different devices to achieve arterial closure . Methods : In a prospect i ve trial 450 patients were r and omized to AS , SC , or MC . Patients were mobilized 1 to 2 hr after device placement , and 6 hr after MC . Data were collected during hospital admission and by telephone at one month after hospital discharge . Results : Devices were used in 138/150 allocated to AS and 124/150 allocated to SC patients ( 92 % vs. 83 % , P = 0.015 ) Patients with MC experienced more pain during sheath removal than patients receiving a device , and rated their period of bed rest as less comfortable . Oozing and need for pressure b and age at the puncture site were observed in 37 AS patients and 57 SC patients ( 25 % vs. 38 % , P = 0.002 ) . Hematoma occurred in 15 AS patients , in 17 SC patients , and in 14 MC patients ( 11 vs. 14 vs. 9 % , ns ) . Conclusion : There is no difference in safety between the three methods of arterial closure . SC was more often not used or successfully deployed . SC patients more often had continuing oozing . On patient comfort , closure devices performed better than MC . Early ambulation in patients with a closure device is safe . AS is the preferred method of arterial closure after cardiac catheterization . © 2008 Wiley‐Liss , Despite advances in other aspects of cardiac catheterization , manual or mechanical compression followed by 4 to 8 hours of bed rest remains the mainstay of postprocedural femoral access site management . Suture-mediated closure may prove to be an effective alternative , offering earlier sheath removal and ambulation , and potentially a reduction in hemorrhagic complications . The Suture To Ambulate aNd Discharge trial ( ST AND I ) evaluated the 6Fr Techstar device in 20 
    Output:
    
However , both metal clip-based and suture-based VCDs were associated with reduced time to haemostasis when compared with extrinsic compression .
No difference was demonstrated in the incidence of vascular injury or mortality when VCDs were compared with extrinsic compression .
No difference was demonstrated in the efficacy or safety of VCDs with different mechanisms of action .