Clinical Research|Articles in Press

Costs and budget impact of collagen-based vascular closure device versus manual compression following peripheral endovascular procedures

Published:March 01, 2023DOI:


      • Increase the probability that the procedure can be performed on a day-case basis.
      • Cost saving £4.5 million annually for the National Health Service in England
      • Cost savings of £176 per procedure due to fewer inpatient stays.
      • Decrease the resource use and cost burden associated with endovascular procedures.



      To evaluate the annual costs and budget impact of using a vascular closure device to achieve haemostasis following femoral access endovascular procedures in England, compared with manual compression.


      A budget impact model was developed in Microsoft® Excel, based on the estimated number of peripheral endovascular procedures eligible for day-case management performed annually by the National Health Service in England. The clinical effectiveness of vascular closure devices was captured based on the requirement for inpatient stays and the incidence of complications. Data for endovascular procedures, time to haemostasis, length of hospital stay, and complications were collected from public sources and the published literature. There were no patients involved in this study. Model outcomes are reported as estimated number of bed days and annual costs to the National Health Service for all peripheral endovascular procedures in England, and the average cost per procedure. The robustness of the model was tested in a sensitivity analysis.


      The model estimated savings for the National Health Service of up to £4.5 million annually if vascular closure devices were used in every procedure instead of manual compression. The model estimated an average cost saving of £176 per procedure for vascular closure devices over manual compression, primarily due to fewer inpatient stays. The sensitivity analysis demonstrated that the proportion of day-case procedures for vascular closure devices and manual compression was a key driver of costs and savings.


      The use of vascular closure devices for achieving haemostasis after peripheral endovascular procedures may be associated with lower resource use and cost burden, compared with manual compression, based on shorter time to haemostasis and ambulation and an increased likelihood of a day-case procedure.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bangalore S
        • Bhatt DL
        Femoral arterial access and closure.
        Circulation. 2011; 124: e147-e156
        • Sheth RA
        • Walker TG
        • Saad WE
        • Dariushnia SR
        • Ganguli S
        • Hogan MJ
        • et al.
        Quality improvement guidelines for vascular access and closure device use.
        J Vasc Interv Radiol. 2014; 25: 73-84
      1. The British Society of Interventional Radiology. Fourth Iliac Angioplasty Study Report 2018. Available at:

        • Alshehri AM
        • Elsharawy M
        Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures.
        Int J Angiol. 2015; 24: 133-136
        • Machnik R
        • Pieniążek P
        • Musialek P
        • Przewłocki T
        • Ł Tekieli
        • Trystula M
        • et al.
        Control of local haemostasis with the AngioSeal (R) vascular closure device in peripheral endovascular interventions via 6-9 F femoral artery access.
        Advances in Interventional Cardiology. 2012; 1: 1-7
        • Upponi SS
        • Ganeshan AG
        • Warakaulle DR
        • Phillips-Hughes J
        • Boardman P
        • Uberoi R
        Angioseal versus manual compression for haemostasis following peripheral vascular diagnostic and interventional procedures--a randomized controlled trial.
        Eur J Radiol. 2007; 61: 332-334
        • Cox T
        • Blair L
        • Huntington C
        • Lincourt A
        • Sing R
        • Heniford BT
        Systematic Review of Randomized Controlled Trials Comparing Manual Compression to Vascular Closure Devices for Diagnostic and Therapeutic Arterial Procedures.
        Surg Technol Int. 2015; 27: 32-44
        • Duffin DC
        • Muhlestein JB
        • Allisson SB
        • Horne BD
        • Fowles RE
        • Sorensen SG
        • et al.
        Femoral arterial puncture management after percutaneous coronary procedures: a comparison of clinical outcomes and patient satisfaction between manual compression and two different vascular closure devices.
        J Invasive Cardiol. 2001; 13: 354-362
        • Martin JL
        • Pratsos A
        • Magargee E
        • Mayhew K
        • Pensyl C
        • Nunn M
        • et al.
        A randomized trial comparing compression, Perclose Proglide and Angio-Seal VIP for arterial closure following percutaneous coronary intervention: the CAP trial.
        Catheter Cardiovasc Interv. 2008; 71: 1-5
        • Alimi Y
        • Hauguel A
        • Casbas L
        • Magnan PE
        • Pin JL
        • Sabatier J
        • et al.
        French Guidelines for the Management of Ambulatory Endovascular Procedures for Lower Extremity Peripheral Artery Disease.
        Ann Vasc Surg. 2019; 59: 248-258
        • Noori VJ
        • Eldrup-Jorgensen J
        A systematic review of vascular closure devices for femoral artery puncture sites.
        J Vasc Surg. 2018; 68: 887-899
        • Akopian G
        • Katz SG
        Peripheral angioplasty with same-day discharge in patients with intermittent claudication.
        J Vasc Surg. 2006; 44: 115-118
      2. NHS Digital. Hospital Episode Statistics for England. Admitted Patient Care statistics, 2018-19. Available at:

        • Das R
        • Ahmed K
        • Athanasiou T
        • Morgan RA
        • Belli AM
        Arterial closure devices versus manual compression for femoral haemostasis in interventional radiological procedures: a systematic review and meta-analysis.
        Cardiovasc Intervent Radiol. 2011; 34: 723-738
      3. Curtis L, Burns A. Unit Costs of Health and Social Care 2019. Project report. University of Kent. 2019.

        • NHS Supply Chain Limited
        NHS Supply Chain Catalogue. Radiology Consumables, Endoscopy Consumables and Vascular Products - Vascular Products.
        Angioseal 6F. NHS Supply chain standard contract price. 2020; (as at December 1st 2020)
      4. NHS Improvement. National Schedule of Reference Costs 2017/18. Available at:

      5. NHS Improvement. National Schedule of Reference Costs 2018/19. Available at:

      6. Baxter Healthcare. TISSEEL for surgical care: Prescribing information. Available at:

        • British National Formulary
        BNF. 2019; 77
        • Baril DT
        • Ghosh K
        • Rosen AB
        Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population.
        J Vasc Surg. 2014; 60 (669-77.e2)
        • Doyle BJ
        • Ting HH
        • Bell MR
        • Lennon RJ
        • Mathew V
        • Singh M
        • et al.
        Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005.
        JACC Cardiovasc Interv. 2008; 1: 202-209
        • Kwok CS
        • Kontopantelis E
        • Kinnaird T
        • Potts J
        • Rashid M
        • Shoaib A
        • et al.
        Retroperitoneal Hemorrhage After Percutaneous Coronary Intervention: Incidence, Determinants, and Outcomes as Recorded by the British Cardiovascular Intervention Society.
        Circ Cardiovasc Interv. 2018; 11e005866
        • Robertson L
        • Andras A
        • Colgan F
        • Jackson R
        Vascular closure devices for femoral arterial puncture site haemostasis.
        Cochrane Database Syst Rev. 2016; 3: Cd009541
        • Zaman I
        • Ali T
        • O'Neil C
        • Pyneeandee R
        • Krokidis M
        Antegrade use of a collagen based vascular closure device for day case peripheral stenting: when can we safely discharge the patients?.
        Hellenic Journal of Radiology. 2019; 4: 1-8
        • Hauguel A
        • Maurel B
        • Bague N
        • Gouaillier-Vulcain F
        • Costargent A
        • Chaillou P
        • et al.
        Management of ambulatory (day case) endovascular procedures for peripheral arterial disease.
        J Cardiovasc Surg (Torino). 2017; 58: 293-304
      7. British Society of Interventional Radiology, The Royal College of Radiologists. Investing in the interventional radiology workforce: the quality and efficiency case. Last accessed 6 Dec 2019.

      8. British Society of Interventional Radiology. Defining and Developing the Interventional Radiology Workforce. 2013. Last accessed 6 Dec 2019.