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Closure devices

What are vascular closure devices?

Once a minimally invasive procedure has been performed, the interventional radiologist will remove the devices used during the procedure, such as catheters or sheaths. At this point, patients usually experience some minor bleeding at the access point for the procedure. Physicians tend to stop this bleeding using a technique called manual compression, in which they manually apply pressure to the site for 15-20 minutes. The patient then has to stay immobile for 4-6 hours.

Although this method generally works well, it is time-consuming and often uncomfortable for the patient. Further, this technique is not effective in some patients.

Vascular closure devices provide an alternative to manual compression. First introduced in the early 1990s, they are specially designed to stop bleeding more quickly, which is both more comfortable for patients and allows them to start moving around sooner.

 

How do closure devices work?

Vascular closure devices are inserted at the end of a procedure. The devices available fall into two categories, passive closure devices and active closure devices. Passive vascular closure devices stop the bleeding with the use of material that leads to the formation of blood clots or by way of mechanical compression. However, these do not stop bleeding particularly rapidly and patients must remain immobile for the same amount of time as with manual compression.

Active vascular closure devices use a variety of methods to directly close the entry site in the artery. For example, such devices include collagen-based and suture-based products or clips. These effectively close the access site, but often require part of the device to remain in the artery, which can cause complications.

Newer devices use materials, such as polyethylene glycol, that dissolve after a short period of time. These are applied to the outside of the artery only and so are considered a more gentle option.

 

Why use them?

Using vascular closure devices causes less pain and discomfort to patients compared to manual compression. These devices also stop bleeding more quickly, meaning that, following a procedure, patients can move about and leave the hospital sooner than if other techniques had been used.

The devices can be especially beneficial for older and less healthy patients, who may be unable to lie flat on their backs for several hours. They are also a welcome alternative for patients for whom manual compression is generally not effective, such as those who suffer from blood clotting disorders or who are obese. Similarly, they are useful for patients who undergo procedures that require large arterial access (such as endovascular aortic aneurysm repair). For these patients, manual compression can be difficult and usually does not work well, so vascular closure devices provide a better option.

 

What are the risks?

Complications can occur, but these are rare. The most common complication is that the device fails (which occurs in less than 6% of cases). When this happens, the physician must immediately resort to manual compression. Sometimes the bleeding occurs after some delay, but this also involves applying simple manual compression to the site. Most of the devices entail a small risk of a blockage in the target artery. The risk of infection is very low (less than 1%).

 

Bibliography

1. D. Scheinert MD, et al., The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx, Catheterization and Cardiovascular Interventions 2007; 70: 627-633.

2. Abu-Fadel MS, Sparling JM, Zacharias SJ, et al., Fluoroscopy vs. traditional guided femoral arterial access and the use of closure devices: A randomized controlled trial, Catheter Cardiovasc Interv 2009; 74: 533–539.

 

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