Vascular closure devices

Jump to navigation Jump to search

Percutaneous coronary intervention Microchapters


Patient Information


Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

Pharmacotherapy to Support PCI

Vascular Closure Devices

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post-PCI Management

Risk Reduction After PCI

Post-PCI follow up

Hybrid coronary revascularization

PCI approaches

PCI Complications

Factors Associated with Complications
Vessel Perforation
Distal Embolization
Coronary Vasospasm
Abrupt Closure
Access Site Complications
Peri-procedure Bleeding
Renal Failure
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
Distal Anastomotic Lesions
Left Main Intervention
The Thrombotic Lesion

Vascular closure devices On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Vascular closure devices

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Vascular closure devices

CDC on Vascular closure devices

Vascular closure devices in the news

Blogs on Vascular closure devices

Directions to Hospitals Treating Percutaneous coronary intervention

Risk calculators and risk factors for Vascular closure devices

Editor-In-Chief: Michael S. Fenster, MD [1]

Vascular Closure Devices

At the very heart of any successful endovascular procedure is successful arterial entry and exit. The first successful cardiac catheterization, according to Andre Cournand, was performed on an equine patient in 1844 utilizing a retrograde approach through both the jugular vein and carotid artery[1]. Human retrograde left heart catheterization was first reported by Zimmerman[2] and Limon-Lason[3] in 1950. Shortly thereafter in 1953, Seldinger developed the percutaneous technique and this technique was quickly adapted to left heart cardiac catheterizations. With the growth of Interventional Cardiology in the years following Grüntzig’s introduction of coronary angioplasty in 1977[4], the percutaneous approach became, and today remains, by far the most common method of performing catheterization, angiography and endovascular intervention.

Within the realm of percutaneous approaches, the majority of the procedures are performed from the femoral approach, with a minority being done from a radial approach. Brachial and axillary are also used in a minority of procedures[5]. Reasons for the continued preference of the femoral route for access includes the vessel size, operator training and equipment, radiation exposure (operator), and the advent of vascular closure devices. Studies have suggested that between 8-10% of all patients selected for a transradial approach will convert to a transfemoral route.[6] [7] [8]

Current Limitations of Vascular Closure Devices



2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[9]

Vascular Closure Devices (DO NOT EDIT)[9]

Class I
"1. Patients considered for vascular closure devices should undergo a femoral angiogram to ensure their anatomic suitability for deployment. (Level of Evidence: C)"
Class III (No Benefit)
"1. The routine use of vascular closure devices is not recommended for the purpose of decreasing vascular complications, including bleeding.[10][11][12][13][14][15] (Level of Evidence: B)"
Class IIa
"1. The use of vascular closure devices is reasonable for the purposes of achieving faster hemostasis and earlier ambulation compared with the use of manual compression.[10][11][12][13](Level of Evidence: B)"


  1. Cournand A (1975). "Cardiac catheterization; development of the technique, its contributions to experimental medicine, and its initial applications in man". Acta Medica Scandinavica. Supplementum. 579: 3–32. PMID 1101653. |access-date= requires |url= (help)
  2. ZIMMERMAN HA, SCOTT RW, BECKER NO (1950). "Catheterization of the left side of the heart in man". Circulation. 1 (3): 357–9. PMID 15405704. Retrieved 2012-10-08. Unknown parameter |month= ignored (help)
  3. Mueller RL, Sanborn TA (1995). "The history of interventional cardiology: cardiac catheterization, angioplasty, and related interventions". American Heart Journal. 129 (1): 146–72. PMID 7817908. Retrieved 2012-10-08. Unknown parameter |month= ignored (help)
  4. Grüntzig A, Schneider HJ (1977). "[The percutaneous dilatation of chronic coronary stenoses--experiments and morphology]". Schweizerische Medizinische Wochenschrift (in German). 107 (44): 1588. PMID 918625. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, Vassanelli C, Zardini P, Louvard Y, Hamon M (2004). "Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials". Journal of the American College of Cardiology. 44 (2): 349–56. doi:10.1016/j.jacc.2004.04.034. PMID 15261930. Retrieved 2012-10-08. Unknown parameter |month= ignored (help)
  6. Guillard N, Lefèvre, Spaulding C, Funck F, Py A, Chalet Y, Thebault B, Chauveau M, Guérin F (1997). "[Coronary angiography by left radial approach. A bi-center prospective pilot study]". Archives Des Maladies Du Coeur Et Des Vaisseaux (in French). 90 (10): 1349–55. PMID 9539834. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  7. Hildick-Smith DJ, Walsh JT, Lowe MD, Shapiro LM, Petch MC (2004). "Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 61 (1): 60–6. doi:10.1002/ccd.10708. PMID 14696161. Retrieved 2012-10-08. Unknown parameter |month= ignored (help)
  8. Achenbach S, Ropers D, Kallert L, Turan N, Krähner R, Wolf T, Garlichs C, Flachskampf F, Daniel WG, Ludwig J (2008). "Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 72 (5): 629–35. doi:10.1002/ccd.21696. PMID 18798237. Retrieved 2012-10-08. Unknown parameter |month= ignored (help)
  9. 9.0 9.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  10. 10.0 10.1 Biancari F, D'Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A (2010). "Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty". American Heart Journal. 159 (4): 518–31. doi:10.1016/j.ahj.2009.12.027. PMID 20362708. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  11. 11.0 11.1 Dauerman HL, Applegate RJ, Cohen DJ (2007). "Vascular closure devices: the second decade". Journal of the American College of Cardiology. 50 (17): 1617–26. doi:10.1016/j.jacc.2007.07.028. PMID 17950141. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  12. 12.0 12.1 Koreny M, Riedmüller E, Nikfardjam M, Siostrzonek P, Müllner M (2004). "Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis". JAMA : the Journal of the American Medical Association. 291 (3): 350–7. doi:10.1001/jama.291.3.350. PMID 14734598. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  13. 13.0 13.1 Patel MR, Jneid H, Derdeyn CP, Klein LW, Levine GN, Lookstein RA, White CJ, Yeghiazarians Y, Rosenfield K (2010). "Arteriotomy closure devices for cardiovascular procedures: a scientific statement from the American Heart Association". Circulation. 122 (18): 1882–93. doi:10.1161/CIR.0b013e3181f9b345. PMID 20921445. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  14. Hoffer EK, Bloch RD (2003). "Percutaneous arterial closure devices". Journal of Vascular and Interventional Radiology : JVIR. 14 (7): 865–85. PMID 12847195. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  15. Nikolsky E, Mehran R, Halkin A, Aymong ED, Mintz GS, Lasic Z, Negoita M, Fahy M, Krieger S, Moussa I, Moses JW, Stone GW, Leon MB, Pocock SJ, Dangas G (2004). "Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis". Journal of the American College of Cardiology. 44 (6): 1200–9. doi:10.1016/j.jacc.2004.06.048. PMID 15364320. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources