Friday, August 31, 2012

Arterial Closure Devices

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.

1 comment:

  1. Thanks for the info, Dr. Gilani. Also thanks for taking over the blog. I'm glad I randomly checked this bookmark today to see your new posts since June.

    Regarding this topic, I've seen this to be very operator dependent. Use of a devices also varies depending on where you are (ie. east coast vs midwest in my experience). I personally would like to use these devices as a fellow and as an attending in the future. Currently as a resident, we hold the groins on all patients as our attendings have not had good results. I've even seen one of my attendings go through 3 devices (same model) on one patient before giving up. Quality control was thought to be the issue by manufacturer, esp given this attending was very experienced with use of acds. Thanks for the overview and reference.


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