Vascular Closure DevicesThe 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
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Figure 1 The First Decade of Vascular Closure Devices
The first decade of vascular closure devices according to their year of Food and Drug Administration approval. During this transition from bare-metal to drug-eluting stent eras, other factors may have influenced vascular complication rates (i.e., percutaneous coronary intervention pharmacology). GP = glycoprotein.
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Figure 2 Overview of Vascular Closure Device Types
Vascular closure methods are: 1) passive and delayed—manual compression with assistance (Femostop) or enhancement (patches); and 2) active and immediate—collagen-based with or without anchor and suture, suture-based, and staple/clip-mediated.
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Figure 3 The Declining Rate of Vascular Complications
Over the past 5 years, major vascular complications have decreased among patients undergoing percutaneous coronary intervention (PCI) in the Northern New England Cardiovascular Disease Study Group. *Arterial injury and/or arterial injury-related bleeding (n = 36,631 patients undergoing PCI).
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Figure 4 High-Risk Femoral Anatomy
Nonideal femoral anatomy includes patients with femoral arterial disease and sheath insertion outside the common femoral artery. Utilization of vascular closure devices in these situations warrants further study.
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Figure 5 Intravascular Versus Extravascular Closure Devices
New staple- and clip-mediated (StarClose or Angiolink) vascular closure devices have a potential advantage of being "extravascular" with no anchor (Angio-Seal) or suture (Perclose). This may be especially significant in situations where minor femoral artery lumen compromise would be clinically consequential (i.e., mild-moderate femoral arterial disease).
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