Vascular Closure Devices

Authors: Dr Tuan Phan*
                            Dr Stuart Lyon *

What are the prerequisites for having vascular closure devices inserted?

A vascular closure device is a mechanical closure of the arteriotomy designed to provide immediate haemostasis after an angiogram. Devices can either be a piece of collagen, a metallic clip or a suture.

The decision to use a vascular closure device at the completion of an angiographic procedure is made by the clinician carrying out the angiographic procedure. Referrers should have a general awareness of the decision making process surrounding vascular closure devices, so that appropriate clinical information can be provided as part of the request for the angiographic procedure.

Factors that would influence the use of a vascular closure device after angiography are:

• Special need to shorten time to ambulation and discharge after an angiographic procedure.
• Large size sheath used during angiographic procedure (size >8f)
• Obesity and other situations where manual compression following the procedure is difficult.
• Older, sicker, or patients who are unable to lie flat for prolonged periods.
• Need to reduce bleeding complications, such as the requirement to have the angiographic procedure while anticoagulated, or to commence anticoagulation or antiplatelet agents after the angiographic procedure.

The radiologist carrying out the angiographic procedure will make the decision about whether a manual closure device or simple compression of the puncture site with a finger will be used to stop the bleeding at the end of the procedure. Referrers need to know about these devices because of potential complications that can occur if these devices are used instead of manual compression.

What are the adverse effects of having vascular closure devices inserted?

In most cases, vascular closure devices work to stop bleeding from the artery immediately. Very rarely, certain complications can occur. The main complications include:

Obstructing foreign body (less than 1%) presenting as new onset claudication or critical limb ischaemia.

Infection (less than 1%). This usually becomes apparent approximately 1 week after the procedure, presenting as pain, swelling, redness and fever. Treatment of infection is with antibiotics and, in severe cases, surgical drainage and exploration.

Delayed bleeding (2.5-5% of cases). This may indicate a pseudoaneurysm, which can clot spontaneously and either resolve itself or persist, and be at risk of rupture and further bleeding.

Persistent puncture site pain post procedure and if this persists longer than 1 week the proceduralist should be contacted.

Other complications are those of the angiographic procedure (see Angiography)

Are there alternative imaging tests, interventions or surgical procedures to insertion of vascular closure devices?

Manual compression is the most commonly used method for haemostasis after an angiographic procedure. In most cases, it is very successful, but typically involves compression for at least 10 minutes, followed by approximately 4 hours of bed rest with the patient lying flat. Manual compression is uncomfortable for the patient during the period of compression. Longer duration of compression is required in patients with larger sheaths, coagulopathy or on anticoagulation. Manual compression is less successful in larger patients. Patients who are unable to lie flat for the 4 hour duration are at an increased risk of bleeding.

*The author has no conflict of interest with this topic.

Page last modified on 30/8/2018.