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STATE-OF-THE-ART PAPER

Vascular Closure Devices

The Second Decade

Harold L. Dauerman, MD, FACC^_*,_*, Robert J. Applegate, MD, FACC and David J. Cohen, MD, MSc

^_* Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont
Division of Cardiology, Wake Forest University Medical Center, Winston-Salem, North Carolina
Saint Luke's Mid-America Heart Institute, Kansas City, Missouri

Manuscript received May 3, 2007; revised manuscript received July 5, 2007, accepted July 15, 2007.

^_* Reprint requests and correspondence: Dr. Harold L. Dauerman, University of Vermont College of Medicine, Fletcher Allen Health Care, 111 Colchester Avenue, McClure 1 Cardiology, Burlington, Vermont 05401. (Email: harold.dauerman{at}vtmednet.org).

Vascular closure devices (VCDs) introduce a novel means for improving patient comfort and accelerating ambulation after invasive cardiovascular procedures performed via femoral arterial access. Vascular closure devices have provided simple, rapid, and reliable hemostasis in a variety of clinical settings. Despite more than a decade of development, however, VCD utilization has neither been routine in the U.S. nor around the world. Their limited adoption reflects concerns of higher costs for cardiac procedures and a lack of data confirming a significant reduction in vascular complications compared with manual compression. Recent data, however, suggest that VCD are improving, complication rates associated with their use may be decreasing, and their utilization may improve the process of care after femoral artery access. Challenges in the second decade of VCD experience will include performing definitive randomized trials, evaluating outcomes in higher-risk patients, and developing more ideal closure devices.

Abbreviations and Acronyms   PCI = percutaneous coronary intervention   VCD = vascular closure device

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