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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
- Active closure devices
- Suture-mediated closure
- Perclose ProGlide (Abbott Vascular)
- Introduced over guidewire through arteriotomy
- Nonresorbable polypropylene monofilament suture closes arteriotomy
- Mechanism parallels surgical suture closure
- Can close arteriotomies ranging in size from 5-21 French; 2 devices using preclose technique available for > 8-French size
- ProStar XL available for arteriotomies up to 10 French in size
- Perclose ProGlide (Abbott Vascular)
- Nitinol clip
- StarClose SE (Abbott Vascular)
- Delivers nitinol clip to close access site
- Can close arteriotomies up to 6 French in size
- MR conditional following application
- StarClose SE (Abbott Vascular)
- Arteriotomy tamponade
- Catalyst (Cardiva Medical)
- Device inserted through existing access sheath; sheath exchange not required
- Nitinol disc expanded within vessel, then collapsed & pulled through arteriotomy/tract
- Extravascular tract exposed to hemostatic coating; promotes hemostasis, prevents oozing
- Brief manual compression after disc withdrawal
- Catalyst II & Catalyst III variants; Catalyst III adds protamine sulfate to neutralize heparin in access tract
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Catalyst (Cardiva Medical)
- Mechanical seal
- Mynx (Cardinal Health)
- Extravascular polyethylene glycol sealant deposited, seals access tract/arteriotomy
- Fully absorbed in 30 days
- Device inserted through existing access sheath; sheath exchange not required
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Intravascular occlusion balloon used during sealant deployment
- Vascade (Cardiva Medical)
- Extravascular collagen plug deposited, seals access tract/arteriotomy
- Temporary intravascular disc maintains stasis while plug deployed, disc then removed
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Angio-Seal (St. Jude Medical)
- Extravascular collagen sponge connected by self-tightening suture to intravascular polymer anchor (absorbable)
- Creates "sandwich" at arteriotomy between anchor & collagen sponge
- All components absorbed within 60-90 days
- 2 device sizes: Maximum 6-French or 8-French arteriotomy
- Access 1 cm proximal to previous access site if repuncture < 90 days
- Exoseal (Cardinal Health)
- Extravascular polyglycolic acid plug sealant
- Fully absorbed in 60-90 days
- Device inserted through existing access sheath; sheath exchange not required
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 12 cm in length)
- Femoral Introducer Sheath & Hemostasis (FISH) (Morris Innovative)
- Closure device placed during initial access
- Ribbon of small intestinal submucosa mounted on sheath introducer; creates resorbable plug
- Can close arteriotomies up to 8 French in size
- Can be used in vessels as small as 3 mm
- Closer (Rex Medical)
- Intraluminal patch & extraluminal spheres cinched together with suture
- Polylactide-co-glycolide acid copolymers, which absorb over time
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Mynx (Cardinal Health)
- Suture-mediated closure
- Assisted compression devices
- Pressure-assisted devices
- Safeguard (Datascope)
- Pneumatic compression device
- Inflatable "bladder" with adhesive backing
- When inflated, applies direct pressure
- 12-mm & 24-mm sizes available
- FemoStop (St. Jude Medical)
- Pneumatic compression device
- Digital manometer; transparent, inflatable dome
- QuicKlamp (TZ Medical)
- Mechanical compression clamp device
- Uses compression discs
- May attach hemostasis pad to disc
- Safeguard (Datascope)
- Radial artery compression devices
- Safeguard Radial (Merit Medical)
- Pneumatic compression device
- Clear window for visualization of puncture site
- Uses standard Luer valve
- TR Band (Terumo Medical)
- Pneumatic compression device
- Transparent structure for visual control of puncture site
- Velcro straps
- RadiStop (St. Jude Medical)
- Pneumatic compression device
- Support plate enables controlled positioning of patient’s wrist
- RadAR (Advanced Vascular Dynamics)
- Strap with adjustment knob & movable compression pad that applies direct pressure to puncture site
- RADstat (Merit Medical)
- Support base & straps provide immobilization of wrist & adjustable direct pressure on puncture site
- Safeguard Radial (Merit Medical)
- Pressure-assisted devices
- Topical hemostasis pads & patches
- Chito-Seal (Abbott Vascular)
- Positively charged chitosan molecules attract negatively charged red blood cells/platelets
- Clo-Sur P.A.D. (Scion Cardio-Vascular)
- Chitosan (N-acetyl glucosamine-containing glycosaminoglycan)
- D-Stat (Vascular Solutions)
- Lyophilized pad with thrombin, Na⁺ carboxymethyl cellulose, Ca⁺⁺ chloride
- V+Pad (Angiotech)
- D-glucosamine-enriched gauze fibers attract platelets for more rapid plug formation
- Syvek patch (Marine Polymer Tech)
- Poly-N-acetyl glucosamine; promotes clot formation/local vasoconstriction
- SafeSeal (Medrad/Possis)
- Bioabsorbable desiccant; enhances clotting
- Chito-Seal (Abbott Vascular)
- Hybrid
- Axera (Arstasis)
- Access/closure device placed during initial access
- Creates pathway traversing artery at shallow angle
- Uses hydrostatic forces to facilitate arterial closure when sheath withdrawn
- Axera (Arstasis)
- Active closure devices
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
- Goldsweig AM et al: Vascular access and closure for peripheral arterial intervention. Interv Cardiol Clin. 9(2):117-24, 2020
- Noori VJ et al: A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg. 68(3):887-99, 2018
- Fargen KM et al: Occurrence of angiographic femoral artery complications after vascular closure with Mynx and AngioSeal. J Neurointerv Surg. 5(2):161-4, 2013
- Das R et al: Arterial closure devices versus manual compression for femoral haemostasis in interventional radiological procedures: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 34(4):723-38, 2011
- Fargen KM et al: A prospective randomized single-blind trial of patient comfort following vessel closure: extravascular synthetic sealant closure provides less pain than a self-tightening suture vascular compression device. J Neurointerv Surg. 3(3):219-23, 2011
- Biancari F et al: Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 159(4):518-31, 2010
- Lee SW et al: Long term clinical outcomes after deployment of femoral vascular closure devices in coronary angiography and percutaneous coronary intervention. Catheter Cardiovasc Interv. 75(3):345-8, 2010
- McTaggart RA et al: StarClose vascular closure device: safety and efficacy of deployment and reaccess in a neurointerventional radiology service. AJNR Am J Neuroradiol. 31(6):1148-50, 2010
- Franco J et al: Risk factors for infectious complications with angio-seal percutaneous vascular closure devices. Vascular. 17(4):218-21, 2009
- Garcia JA et al: Use of the Boomerang catalyst advantage closure device to facilitate complex multistaged percutaneous revascularization procedures for the treatment of critical limb ischemia. Catheter Cardiovasc Interv. 74(1):27-36, 2009
- Lima S et al: Femoral stenosis due to a collagen closure device treated percutaneously by peripheral stenting. Rev Port Cardiol. 28(7-8):877-80, 2009
- van der Steeg HJ et al: Acute arterial occlusion after deployment of the Angio-Seal closure device: is it as uncommon as we think? Eur J Vasc Endovasc Surg. 38(6):715-7, 2009
- Germing A et al: Femoral vascular closure device: the surgical view. Vascular. 16(5):295-6, 2008
- Lee WA et al: Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the preclose technique. J Vasc Surg. 47(5):919-23, 2008
- Koreny M et al: Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA. 291(3):350-7, 2004
- Hofmann LV et al: Arteriographic and pathologic evaluation of two suture-mediated arterial closure devices in a porcine model. J Vasc Interv Radiol. 14(6):755-61, 2003
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
- Active closure devices
- Suture-mediated closure
- Perclose ProGlide (Abbott Vascular)
- Introduced over guidewire through arteriotomy
- Nonresorbable polypropylene monofilament suture closes arteriotomy
- Mechanism parallels surgical suture closure
- Can close arteriotomies ranging in size from 5-21 French; 2 devices using preclose technique available for > 8-French size
- ProStar XL available for arteriotomies up to 10 French in size
- Perclose ProGlide (Abbott Vascular)
- Nitinol clip
- StarClose SE (Abbott Vascular)
- Delivers nitinol clip to close access site
- Can close arteriotomies up to 6 French in size
- MR conditional following application
- StarClose SE (Abbott Vascular)
- Arteriotomy tamponade
- Catalyst (Cardiva Medical)
- Device inserted through existing access sheath; sheath exchange not required
- Nitinol disc expanded within vessel, then collapsed & pulled through arteriotomy/tract
- Extravascular tract exposed to hemostatic coating; promotes hemostasis, prevents oozing
- Brief manual compression after disc withdrawal
- Catalyst II & Catalyst III variants; Catalyst III adds protamine sulfate to neutralize heparin in access tract
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Catalyst (Cardiva Medical)
- Mechanical seal
- Mynx (Cardinal Health)
- Extravascular polyethylene glycol sealant deposited, seals access tract/arteriotomy
- Fully absorbed in 30 days
- Device inserted through existing access sheath; sheath exchange not required
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Intravascular occlusion balloon used during sealant deployment
- Vascade (Cardiva Medical)
- Extravascular collagen plug deposited, seals access tract/arteriotomy
- Temporary intravascular disc maintains stasis while plug deployed, disc then removed
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Angio-Seal (St. Jude Medical)
- Extravascular collagen sponge connected by self-tightening suture to intravascular polymer anchor (absorbable)
- Creates "sandwich" at arteriotomy between anchor & collagen sponge
- All components absorbed within 60-90 days
- 2 device sizes: Maximum 6-French or 8-French arteriotomy
- Access 1 cm proximal to previous access site if repuncture < 90 days
- Exoseal (Cardinal Health)
- Extravascular polyglycolic acid plug sealant
- Fully absorbed in 60-90 days
- Device inserted through existing access sheath; sheath exchange not required
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 12 cm in length)
- Femoral Introducer Sheath & Hemostasis (FISH) (Morris Innovative)
- Closure device placed during initial access
- Ribbon of small intestinal submucosa mounted on sheath introducer; creates resorbable plug
- Can close arteriotomies up to 8 French in size
- Can be used in vessels as small as 3 mm
- Closer (Rex Medical)
- Intraluminal patch & extraluminal spheres cinched together with suture
- Polylactide-co-glycolide acid copolymers, which absorb over time
- Compatible with 5-French, 6-French, & 7-French vascular sheaths (≤ 15.7 cm in length)
- Mynx (Cardinal Health)
- Suture-mediated closure
- Assisted compression devices
- Pressure-assisted devices
- Safeguard (Datascope)
- Pneumatic compression device
- Inflatable "bladder" with adhesive backing
- When inflated, applies direct pressure
- 12-mm & 24-mm sizes available
- FemoStop (St. Jude Medical)
- Pneumatic compression device
- Digital manometer; transparent, inflatable dome
- QuicKlamp (TZ Medical)
- Mechanical compression clamp device
- Uses compression discs
- May attach hemostasis pad to disc
- Safeguard (Datascope)
- Radial artery compression devices
- Safeguard Radial (Merit Medical)
- Pneumatic compression device
- Clear window for visualization of puncture site
- Uses standard Luer valve
- TR Band (Terumo Medical)
- Pneumatic compression device
- Transparent structure for visual control of puncture site
- Velcro straps
- RadiStop (St. Jude Medical)
- Pneumatic compression device
- Support plate enables controlled positioning of patient’s wrist
- RadAR (Advanced Vascular Dynamics)
- Strap with adjustment knob & movable compression pad that applies direct pressure to puncture site
- RADstat (Merit Medical)
- Support base & straps provide immobilization of wrist & adjustable direct pressure on puncture site
- Safeguard Radial (Merit Medical)
- Pressure-assisted devices
- Topical hemostasis pads & patches
- Chito-Seal (Abbott Vascular)
- Positively charged chitosan molecules attract negatively charged red blood cells/platelets
- Clo-Sur P.A.D. (Scion Cardio-Vascular)
- Chitosan (N-acetyl glucosamine-containing glycosaminoglycan)
- D-Stat (Vascular Solutions)
- Lyophilized pad with thrombin, Na⁺ carboxymethyl cellulose, Ca⁺⁺ chloride
- V+Pad (Angiotech)
- D-glucosamine-enriched gauze fibers attract platelets for more rapid plug formation
- Syvek patch (Marine Polymer Tech)
- Poly-N-acetyl glucosamine; promotes clot formation/local vasoconstriction
- SafeSeal (Medrad/Possis)
- Bioabsorbable desiccant; enhances clotting
- Chito-Seal (Abbott Vascular)
- Hybrid
- Axera (Arstasis)
- Access/closure device placed during initial access
- Creates pathway traversing artery at shallow angle
- Uses hydrostatic forces to facilitate arterial closure when sheath withdrawn
- Axera (Arstasis)
- Active closure devices
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
- Goldsweig AM et al: Vascular access and closure for peripheral arterial intervention. Interv Cardiol Clin. 9(2):117-24, 2020
- Noori VJ et al: A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg. 68(3):887-99, 2018
- Fargen KM et al: Occurrence of angiographic femoral artery complications after vascular closure with Mynx and AngioSeal. J Neurointerv Surg. 5(2):161-4, 2013
- Das R et al: Arterial closure devices versus manual compression for femoral haemostasis in interventional radiological procedures: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 34(4):723-38, 2011
- Fargen KM et al: A prospective randomized single-blind trial of patient comfort following vessel closure: extravascular synthetic sealant closure provides less pain than a self-tightening suture vascular compression device. J Neurointerv Surg. 3(3):219-23, 2011
- Biancari F et al: Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 159(4):518-31, 2010
- Lee SW et al: Long term clinical outcomes after deployment of femoral vascular closure devices in coronary angiography and percutaneous coronary intervention. Catheter Cardiovasc Interv. 75(3):345-8, 2010
- McTaggart RA et al: StarClose vascular closure device: safety and efficacy of deployment and reaccess in a neurointerventional radiology service. AJNR Am J Neuroradiol. 31(6):1148-50, 2010
- Franco J et al: Risk factors for infectious complications with angio-seal percutaneous vascular closure devices. Vascular. 17(4):218-21, 2009
- Garcia JA et al: Use of the Boomerang catalyst advantage closure device to facilitate complex multistaged percutaneous revascularization procedures for the treatment of critical limb ischemia. Catheter Cardiovasc Interv. 74(1):27-36, 2009
- Lima S et al: Femoral stenosis due to a collagen closure device treated percutaneously by peripheral stenting. Rev Port Cardiol. 28(7-8):877-80, 2009
- van der Steeg HJ et al: Acute arterial occlusion after deployment of the Angio-Seal closure device: is it as uncommon as we think? Eur J Vasc Endovasc Surg. 38(6):715-7, 2009
- Germing A et al: Femoral vascular closure device: the surgical view. Vascular. 16(5):295-6, 2008
- Lee WA et al: Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the preclose technique. J Vasc Surg. 47(5):919-23, 2008
- Koreny M et al: Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA. 291(3):350-7, 2004
- Hofmann LV et al: Arteriographic and pathologic evaluation of two suture-mediated arterial closure devices in a porcine model. J Vasc Interv Radiol. 14(6):755-61, 2003
