Vascular Access Closure Devices

Excerpt

Minimally invasive techniques continue to evolve in many surgical specialties, and vascular surgery is no exception. Angiography is one of the commonest procedures performed today in a wide variety of specialties including diagnostic and interventional cardiology, vascular surgery and interventional radiology. Traditionally, hemostasis at the access site for these procedures has been obtained via manual compression. While manual compression is the gold standard in this regard, a wide array of vascular access closure devices have been developed to aid the proceduralist in achieving that goal. These devices can be useful in the setting of a large body habitus, anticoagulation and antiplatelet therapy, and in situations where extended bedrest may not be desirable (such as a patient with extensive pressure ulcers). In the case of the former two scenarios, manual compression needs to be applied for an extended period or with considerable force. Complications that can result from inadequate manual compression include hematoma and pseudoaneurysm formation. Studies have shown that use of these devices is safe even when patients have received thrombolytic therapy. We usually employ vascular access closure devices whenever a sheath that is a 6F catheter or larger is used for an arterial procedure.

Vascular access closure devices can be divided into the following categories: suture-mediated closure devices, mechanical non-suture closure devices, intra-vascular sealant devices, extra-vascular sealant devices and manual compression assistance devices. Perclose (Abbott Vascular) is an example of a suture-mediated closure device that provides a pre-tied knot for the closure of the arteriotomy site while allowing maintenance of wire access. StarClose (Abbott Vascular) is an example of a mechanical non-suture closure device. The mechanism of this device is based on a nitinol clip which approximates the adventitia of the artery. Mynx device (CardinalHealth/Cordis) provides an extravascular sealant (polyethylene glycol) while Angioseal (St. Jude Medical) provides an intravascular sealant (bioabsorbable anchor with a collagen plug). The Catalyst II and III devices (Cardiva Medical) provide adjunctive hemostasis with manual compression. Many other devices are also available.