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Vascular Closure: the ABC's
Sukhdeep Bhogal1, Ron Waksman2
1Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA.
Insights
Vascular closure devices (VCDs) offer effective hemostasis for endovascular procedures, proving non-inferior to manual compression. These devices can reduce procedure time and costs while maintaining comparable complication rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular access and closure are critical components of endovascular procedures.
- Access site-related complications independently predict adverse procedural outcomes.
Purpose of the Study:
- To review vascular closure methods, including manual compression and vascular closure devices (VCDs).
- To discuss VCD mechanisms, applications in arterial and venous arteriotomies, and associated complications.
Main Methods:
- Review of literature on vascular closure techniques and devices.
- Analysis of mechanisms of action for active and passive vascular closure devices.
- Examination of clinical outcomes and complication rates associated with different closure methods.
Main Results:
- Vascular closure devices (VCDs) have demonstrated non-inferiority compared to manual compression.
- VCDs reduce time to hemostasis, enabling early ambulation and discharge.
- Hospitalization costs may be reduced with VCD use, with comparable complication rates to manual compression.
Conclusions:
- Uncomplicated vascular closure is essential for preventing adverse procedural outcomes.
- VCDs facilitate faster patient recovery and potentially lower costs.
- Appropriate patient selection for VCDs is important, considering vascular anatomy.
Purpose Of Review:
Vascular access and closure is a key part of endovascular procedures, and access site-related complications are an independent predictor of adverse procedural outcomes. The purpose of this review is to discuss the methods of vascular closure including manual compression, vascular closure devices (VCDs) for both arterial and venous arteriotomies, their mechanisms, and access site-related complications.
Recent Findings:
Various VCDs have been approved over the last three decades. These devices have different mechanisms to achieve hemostasis and are generally categorized into active and passive approximators. Studies have largely found that they are non-inferior to manual compression. Uncomplicated vascular closure is pertinent to avoid adverse procedure-related outcomes. The emergence of VCDs has reduced time to hemostasis, facilitating early ambulation and discharge and reducing hospitalization cost with comparable complication rate to manual compression. Nonetheless, they should be used in favorable vascular anatomy and are not intended to reduce complications.
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