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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Arterial closure devices. A review
J B Madigan1, L A Ratnam, A M Belli
1Radiology Department, St. Georges Hospital, London, UK.
Insights
Arterial closure devices offer comparable safety to manual compression for achieving haemostasis after arterial puncture. No single device demonstrates superiority, highlighting the need for careful selection based on clinical needs and device-specific factors.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Arterial closure devices (ACDs) are increasingly used for haemostasis after arterial puncture.
- Their adoption is driven by the need for efficient and safe methods to control bleeding.
- A comprehensive understanding of available devices is crucial for clinical decision-making.
Purpose of the Study:
- To review currently available arterial closure devices.
- To summarize the supporting literature on their efficacy and safety.
- To compare the advantages, disadvantages, and mechanisms of action of various ACDs.
Main Methods:
- Systematic literature review of studies on arterial closure devices.
- Analysis of device-specific technical aspects, learning curves, and ease of use.
- Evaluation of complication rates and comparison with manual compression.
Main Results:
- The safety profile of ACDs is comparable to manual compression.
- No specific device has shown superiority over others in current literature.
- Heterogeneous patient populations in studies necessitate caution in extrapolating evidence.
- Off-label applications are emerging and require further investigation.
Conclusions:
- Choosing an ACD requires consideration of clinical needs, device specifics, and potential complications.
- While ACDs offer comparable safety, improvements are needed for an ideal device.
- Further research is necessary to evaluate emerging applications and refine device design.
Abstract:
The use of arterial closure devices in achieving haemostasis following arterial puncture has become increasingly popular. This review aims to provide an overview of the currently available closure devices, with an up-to-date summary of the supporting literature. The various devices have their advantages and disadvantages as well as differing mechanisms of actions. Technical aspects of deployment affect the learning curve and ease of use of individual devices. Some complications that arise are device specific where others are related to arterial punctures in general. When choosing a device, all these factors should be taken into account as well as differing clinical requirements and priorities. Most studies of arterial closure devices that are currently in use conclude that the safety profile of closure devices is comparable to manual compression. The literature does not show superiority of any particular device. Caution is advised in extrapolating evidence based on differing patient groups, as many of the study populations are heterogeneous. As physicians become more familiar with the use of closure devices, off-label applications of some devices have emerged, some of which need further evaluation. The ideal closure device should reduce complication rates compared to manual compression, be easy to use with a short learning curve, and have a high rate of deployment success. It should also be usable across a wide range of sheath sizes, not leave any permanent foreign body behind, reduce time to haemostasis and ambulation, allow immediate repuncture, improve patient comfort and be cost effective. In spite of the wide range of devices currently available there remains room for improvement.
