arterial puncture occurs at the start of angiography and interventional radiology , and is a 
 very important factor determining the success or failure of successive procedures . recently , 
 this procedure has been performed by a range of approaches depending on the type of surgery , 
 e.g , through the radial artery . until now , the procedure through the femoral artery has been 
 used most widely as the most basic puncture area for angiography . on the other hand , 
 hemostasis and the pertinent complications are problems in the femoral artery , in which the 
 pressure is high after the procedure and the size of the blood vessels is relatively 
 high . therefore , hemostasis in the puncture area for angiography or interventional radiation is a 
 very important last step of the procedure . the methods of hemostasis for the femoral artery 
 include manual compression , which is the removal of the sheath and compression with the 
 hands , and methods that apply compression devices1 . of these , manual compression requires absolute bed rest for a few 
 hours . on the other hand , the level of patient discomfort is increased due to lengthy bed 
 rest and the restriction of walking . moreover , hematoma in the punctured area of blood 
 vessels , formation of a pseudoaneurysm , and vascular occlusions develop in approximately 
 15% cases2 , 3 . a variety of hemostasis devices have been developed to treat these 
 complications that allow for rapid recovery of patients from bed rest . these include 
 angio - seal device ( collagen sponge and copolymer anchor ) and percutaneous placement of a 
 device ( prostar ) that utilizes two nonabsorbable sutures ( perclose , redwood city , ca , usa ) . the angio - seal device uses a method of adsorption with a collagen sponge placed within the 
 blood vessels . the prostar device uses a method in which the blood vessels are sutured4 , 5 . these hemostasis devices can reduce the discomfort and the time to hemostasis ( clotting 
 time ) in the puncture area when used in patients , who can not lie down in bed for a long time 
 or in patients with low platelet values who have received anti - coagulation treatments . therefore , they allow rapid walking , which shortens the hospitalization period of the 
 patient . at the time of hemostasis , however , hematoma or complications of peripheral blood 
 vessels can occur , and several problems , such as a long time to hemostasis , can develop in 
 patients who have received urokinase and in obese patients . therefore , this study examined the change in complications or success rate of hemostasis 
 according to the hemostasis method . patients , who had received angiography after femoral 
 arterial puncture and hands , or a combination of manual compression and , were enrolled in 
 this study . the subjects were 180 patients who underwent angiography after femoral arterial puncture 
 from november 2010 to august 2011 . the highest 
 proportion of patients were between 50 and 60  years of age ( 48% , 44 cases ) . the distribution of age and gender of the patients ( n = 180)gendertotal ( % ) malefemale30s17724 ( 12.2)40s211334 ( 17.7)50s311243 ( 23.3)60s371047 ( 25.5)70s26632 ( 17.7)total ( % ) 132 ( 73.3)48 ( 26.4)180 ( 100.0 ) ) . in 60 of the patients ( group a : 52.2  9.83  years , 41 males , 19 females ) , 
 femoral arterial hemostasis had been performed after angiography using an angio - seal device 
 ( st . jude medical europe , belgium ) , and compression was performed with a compression device . 
 for another 60 patients ( group b : 50.7  11.23  years , 47 males , 13 females ) , after 
 angiography , hemostasis was performed by compressing the puncture area with the hands . for 
 the remaining 60 patients ( group c : 54.27  12.21  years , 44 males , 16 males ) , after 
 angiography , femoral arterial hemostasis was performed using an angio - seal device and a 
 compression device , and the puncture area was then compressed again with the hands . among 
 the patients who had undergone angiography , those who did not receive a blood test , those 
 who presented with pain during hemostasis , those whose conditions were unstable , and those 
 whose times to hemostasis were not accurate were excluded . all participants signed a written 
 informed consent form approved by the institutional review board at the university of 
 soonchunhyang . for group a , femoral arterial angiography was without abnormal findings immediately after 
 angiography , such as stenosis of blood vessels and , arterial detachment , an angio - seal 
 device was placed in the puncture area of the blood vessel , and a compression device 
 ( easy - stop , tae woong , seoul , republic of korea ) was used ( for compression , refer to fig . an angio - seal device ( a ) was placed in the puncture site of the blood vessels , and 
 the site was compressed using a compression device ( b ) . ) . for group b , after angiography , the sheath inserted into the femoral artery was 
 removed , and the puncture area was compressed with the hands . for group c , immediately after 
 angiography , an angio - seal device was placed in the puncture area of the blood vessel , and 
 the puncture area was compressed for approximately 10  min using a compression device and 
 then compressed with the hands .   an angio - seal device ( a ) was placed in the puncture site of the blood vessels , and 
 the site was compressed using a compression device ( b ) . in each group , after performing angiography , the effect of gender , the time to hemostasis 
 of each generation , the results of blood correlation between hemoglobin value , platelet 
 value , and the time to hemostasis were examined . in addition , the frequency of complications 
 according to the hemostasis methods of each group and incidence were compared . complications 
 were defined as the development of a hematoma > 5  cm , and a decrease in the hemoglobin 
 level to < 3  g / dl . a questionnaire was used to assess the presence or absence of pain 
 after hemostasis . the time to hemostasis after angiography of each group , post hoc analysis was performed using a scheffe s test . through 
 this , the gender of each group and the time to hemostasis of each generation were compared 
 and analyzed . the pearson correlation coefficient was applied to determine the correlation 
 between the hemoglobin value , platelet value , and time to hemostasis . frequency analysis and 
 anova were applied to examine the development frequency of complications according to the 
 hemostasis method of each group and the incidence and frequency . the spss statistical 
 software ( spss , 17.0 , chicago , il , usa ) was applied for statistical analysis . in addition , cases with a 
 pearson correlation coefficient > 0.5 were considered to be correlated . the mean ages of groups a , b , and c were 52.2  9.83 , 50.7  11.23 , and 54.27  
 12.21  years , respectively ; there was no significant difference between the three groups . the 
 male to female ratios in groups a , b , and c were 68.33%:31.66% , 78.33%:21.66% , and 73.33% : 
 26.66% , respectively . the type of tests , 
 hemoglobin , and platelet values were also similar in the three groups ( table 2table 2 . baseline clinical characteristics ( n = 180)group a ( n=60)group b ( n=60)group c ( n=60)age ( mean  sd)52.2  9.8350.7  11.2354.27  12.21male ( % ) 68.3378.3373.33female ( % ) 31.6621.6626.66type of examinationhepatic angiography ( % ) 8 ( 13.33%)5 ( 8.33%)9 ( 10.5%)tfca ( % ) 25 ( 41.66%)22 ( 36.66%)27 ( 45%)tace ( % ) 17 ( 28.33%)16 ( 26.66%)17 ( 28.33%)femoral angiography ( % ) 10 ( 16.66%)4 ( 6.66%)3 ( 5%)coronary angiography ( % ) 10 ( 16.66%)13 ( 21.66%)14 ( 23.33%)blood level ( g / dl)hb13.32  3.2714.27  4.9814.25  4.77plt183.28  23.75176.78  31.25191  24.65tfca , tramsfemoral cerebral angiography ; tace , transcatheter 
 arterial chemoembolization ; hb , hemoglobin ; plt , platelet ; 
 sd , standard deviation ) . tfca , tramsfemoral cerebral angiography ; tace , transcatheter 
 arterial chemoembolization ; hb , hemoglobin ; plt , platelet ; 
 sd , standard deviation groups a , b and c showed a mean times to hemostasis of 20.37  8.23 , 29.30  6.87 , and 28.9 
  7.25  min , respectively . in other words , the time to hemostasis of the compression device 
 ( group a ) was the shortest ( p < 0.05 ) . the correlation coefficient between the time to 
 hemostasis and hemostasis method was 0.58 , indicating a correlation . when the patients were classified according to gender , the time to hemostasis of males was 
 shorter than that of females . in group a , the times to hemostasis of males and females were 
 29.83  5.17 and 28.67  2.38  min , respectively . in group b , the times to hemostasis of 
 males and females were 18.67  2.81 and 21.12  1.89  min , respectively . in group c , the 
 times to hemostasis of males and females were 28.19  2.23 and 31.89  4.87  min , 
 respectively . there were no statistically significant differences according to gender ( p 
 > 0.05 ) . in regard to the hemostasis method according to age , the shortest times in group 
 a , b , and c was respectively , 22.29  5.82  min in those in their 50s , 16.50  9.19  min in 
 those in their 30s , and 24.40  6.27  min in those in their 70s , respectively . no 
 statistically significant differences were observed between the three groups ( p > 0.05 ) . the correlation coefficients between gender , generation , and hemostasis time were 0.232 and 
 0.125 , indicating no correlation ( table 
 3table 3 . hemostasis time according to gender and generation ( unit :  min)gendermean  sdgroup a ( n=60)group b ( n=60)group c ( n=60)male29.83  5.1718.67  2.8128.19  2.23female28.67  2.3821.12  1.8931.89  4.87generationmean  sd30s26.35  3.2516.50  9.1930.67  9.4040s32.43  16.5719.25  9.7830.23  8.9450s22.29  5.8218.14  5.9825.43  10.9460s28.00  9.4220.43  9.8135.83  18.2870s32.80  13.1021.83  7.4124.40  6.27sd , standard deviation ) . sd , standard deviation in each hemostasis method , the correlation between the hemoglobin value , platelet value , 
 and the time to hemostasis was examined . the correlation coefficients for the association 
 between the time to hemostasis and the hemoglobin and platelet values in group a were 0.249 
 and 0.085 , respectively . in group b , the correlation coefficients for the association 
 between the time to hemostasis and the hemoglobin and platelet values were 0.012 and 
 0.207 , respectively . in group c , the correlation coefficient for the association between 
 the time to hemostasis and the hemoglobin and platelet values were 0.200 and 0.206 , 
 respectively . in each hemostasis method , although the hemoglobin or platelet values showed 
 slight individual differences , the overall value was significantly different ( table 4table 4 . correlation between hemoglobin , platelet value , and the time to 
 hemostasishbpltgroup apearson correlation coefficient0.2490.085group bpearson correlation coefficient0.0120.207group cpearson correlation coefficient0.2000.206hb , hemoglobin ; plt , platelet ) . hb , hemoglobin ; plt , platelet fifteen patients ( 25.0% ) in group a had complications ; 5 ( 8.33% ) showed a hematoma size 
 > 5  cm , and 10 ( 16.66% ) presented with pain . no complications developed in group b. in 
 group c , 9 patients ( 15.0% ) had complications ; 2 ( 3.33% ) showed a hematoma size > 5  cm , 
 and 7 ( 11.66% ) presented with pain . therefore , complications developed at the highest rate 
 when hemostasis was carried out using a compression device only ( p < 0.05 ) . with the development of interventional radiology , arterial puncture has played an important 
 role in the initiation of surgery . although a range of approach routes can be applied 
 according to the type of surgery , it is generally performed via the femoral artery approach , 
 and the common femoral artery has been shown to be the ideal puncture site . the risk of 
 intra - abdominal or retroperitoneal bleeding is high if the proximal area of the inguinal 
 ligament , i.e. , the external iliac artery , is punctured , which might injure the inguinal 
 canal and intra - abdominal structures . laceration of blood vessels , pseudoaneurysm , 
 arteriovenous fistula , thrombosis , and excess bleeding can develop if the distal area of the 
 common femoral artery , i.e. , the deep femoral artery of the superficial femoral artery , is 
 punctured6 , 7 . previously , at the time of hemostasis after surgery , manual compression that using the 
 hands as well as hemostasis using compression devices have been performed . recently , 
 patients have been able to walk within 12 h , and the discomfort of patients caused by 
 lengthy bed rest and a lengthy hospitalization period has been reduced using the arterial 
 closure device , angio - seal arterial closure device4 , 
 5 . on the other hand , when compression 
 devices are used , infections in the inguinal area , acute arterial occlusion , and other large 
 and small complications have been reported8 . nicolas reported that in the group that used a hemostasis device , a 
 pseudoaneurysm developed in 1 case ( 0.60%)9 . in addition , among 156 cases , allergic reactions or inguinal 
 hematoma developed in 18 cases ( 11.5% ) . the results 
 showed that side effects occurred 15 patients ( 25.0% ) using compression devices ; 5 patients 
 ( 8.33% ) had a hematoma > 5  cm , and 10 patients ( 16.66% ) presented with pain . when hemostasis was performed 
 with a compression device and the hands together , 9 patients ( 15.0% ) had complications , 2 
 patients ( 3.33% ) had a hematoma > 5  cm , and 7 patients ( 11.66% ) presented with pain . in 
 other words , the highest rate of complications developed when hemostasis was performed only 
 with compression devices . in addition to side effects , the following correlations were compared : between the time to 
 hemostasis after angiography and gender ; the time to hemostasis of each generation and 
 hemoglobin value ; and platelet value and the time to hemostasis . in manual hemostasis , the 
 mean time to hemostasis was 20  min , which was the shortest . on the other hand , the mean time 
 was 28  min when a compression device was used . when compressed with a compression device and 
 subsequently with the hands , other studies measured the period 
 from hemostasis to walking , not the time to hemostasis . jeong et al . reported that walking 
 was possible 7.2  2.7  h after hemostasis with a compression device , and 17.3  4.3  h after 
 manual hemostasis10 . showed 
 that the period to the initiation of walking was 7.9  h when hemostasis was carried out using 
 compression devices11 . the results of the 
 present study were different from the above results , and this was attributed to the 
 difference in research methods . in the present study , the interval from angiography to 
 hemostasis was measured instead of the time to walking , which can explain the different 
 results . in addition , there was no difference in the time to hemostasis according to gender 
 or generation , and the correlations of the hemoglobin value , platelet value , and the time to 
 homeostasis were not significant . therefore , gender , age , hemoglobin value , and platelet 
 value have no significant involvement in hemostasis . manual hemostasis can stop bleeding most accurately within a short time with a low 
 incidence of complications . on the other hand , in hemostasis using a compression device , it 
 is difficult to assess the level of pressure that compresses the blood vessels . when a 
 fixation device is inserted , the compression bar is slanted if the bottom surface is not 
 hard . in addition , if 
 patients are unconscious or unstable , the hemostasis points may move due to movement of the 
 patient , resulting in bleeding13 . on the 
 other hand , as in our hospital , if the number of personnel in the angiography room is small 
 ( 1 radiologist , 2 nurses , 1 specialist clinician ) , unnecessary use of professional personnel 
 can be prevented by the application of a compression device . in addition , the discomfort of 
 the person who performs hemostasis by manual compression when bleeding lasts for a long time 
 due to the use of anticoagulants can be resolved , and low - cost equipment can perform the 
 task of one person . therefore , it is anticipated that the turnover of patients can be 
 increased . the incidence of complications and the time to hemostasis are increased when 
 hemostasis is carried out using a compression device . on the other hand , the incidence of 
 side effects and the time to hemostasis are reduced when hemostasis is carried out using the 
 hands . nevertheless , when compression devices are used , unnecessary use of professional 
 personnel can be prevented . in addition , in hemostasis for a long time , the discomfort of 
 the person for whom hemostasis by manual compression is performed can be resolved . overall , 
 hemostasis performed mutually is safe and effective for patients according to their 
 condition .
[ purpose ] this study assessed the advantages and shortcomings of methods for hemostasis 
 in patients who had received angiography after femoral arterial puncture using manual , 
 compression device , or a combination of manual compression and a compression device . in 
 addition , the success rates , complications , etc , were analyzed . 
 [ subjects and methods ] one 
 hundred and eighty patients who had undergone angiography after femoral arterial puncture 
 were divided into three groups according to the method of hemostasis . for group 
 a , 
 immediately after angiography , an angio - seal device was placed in the puncture area and 
 compressed using a compression device . for group b , after angiography , the puncture area 
 was compressed with the hands directly . for group c , 
 the puncture area was compressed 
 using a compression device for approximately 10  min , and the puncture area was then 
 compressed with the hands . in each group , 
 the following correlations were analyzed : the 
 time to hemostasis after angiography and gender , the time to hemostasis of each generation 
 and the hemoglobin value , and platelet value and the time to hemostasis . 
 [ results ] the 
 results showed a similar time to hemostasis regardless of gender or generation . 
 the 
 correlation between the hemoglobin value , platelet value , and the time to hemostasis were 
 not significant . 
 group a showed the shortest mean time to hemostasis of the three groups 
 ( 20.37  8.23  min ) . 
 no complications caused by the hemostasis method were detected in 
 group b. group a showed the highest incidence of complications caused by hemostasis . 
 [ conclusion ] overall , hemostasis performed mutually is safe and effective for patients 
 according to their condition .