Initially used by cardiologists during percutaneous coronary interventions, arterial closure devices (ACDs) have made their way into the interventional radiology suite. With the potential to achieve rapid hemostasis and reducing patient time to ambulation, ACDs are increasingly favored over manual compression for arteriotomies especially since preliminary data demonstrates no significant difference in complications between the two methods.
ACDs can either provide active (or intravascular) closure by engaging the vessel wall via clips, sutures, or plugs, versus passive (or extravascular) closure by introducing thrombosing agents or sealants via the sheath to plug the arteriotomy site. Few clinical trials exist demonstrating the benefit of intravascular versus extravascular closure. It is felt that intravascular ACDs are a better choice in patients who are anticoagulated. However, using a device with intravascular components introduces a nidus for potential infection. Additional complications include device embolization, arterial laceration, and limb ischemia due to luminal obstruction.
While additional research is needed to define the safety and efficacy profiles of ACDs, their use should certainly be considered by interventional radiology departments, especially due to their potential to improve patient care.
Dauerman HL, Applegate RJ, Cohen DJ. Vascular closure devices: the second decade. J Am Coll Cardiol 2007;50(17):1617-26.