Vascular closure devices (VCDs) are medical devices used to achieve

hemostasis In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, whi ...

of the small hole in the artery after a

cardiovascular The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

procedure of

endovascular surgery Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries, veins and lymphatic circulation, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty ...

requiring a catheterization. Cardiovascular procedures requiring catheterization include diagnostic procedures that help diagnose diseased blood vessels and interventional procedures such as

angioplasty Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atheroscle ...

, the placement of a

stent In medicine, a stent is a metal or plastic tube inserted into the lumen of an anatomic vessel or duct to keep the passageway open, and stenting is the placement of a stent. A wide variety of stents are used for different purposes, from expandab ...

and coronary

thrombectomy Mechanical thrombectomy, or simply thrombectomy, is the interventional procedure of removing a blood clot (thrombus) from a blood vessel. It is commonly performed in the cerebral arteries (interventional neuroradiology). The effectiveness of throm ...

. During such procedures, a small incision is made in the

groin In human anatomy, the groin (the adjective is ''inguinal'', as in inguinal canal) is the junctional area (also known as the inguinal region) between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial comp ...

area and a hole is created in the

femoral artery The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the fem ...

to gain access to the artery. This hole is referred to as the access site or puncture site. At the completion of the procedure, the hole needs to be closed. Metal clip-based and suture-based VCDs may reduce time to hemostasis when compared with extrinsic (manual or mechanical) compression. However, no type of VCD has been shown to be more effective or safe than another.

Goals

The main goal of a Vascular Closure Device is to provide rapid

of the artery as well as reduce access site complications. VCD's also help reduce time to ambulation and time to hospital discharge. In addition, VCD's are more comfortable for the patient compared to manual compression.

History

Prior to the development of VCD's, the main method for closing the femoral artery was manual compression. Manual compression involves up to 30 minutes of manual pressure or mechanical clamps applied directly to the patient's groin, which is very painful, followed by up to 8 hours of bed rest in the hospital recovery room. Vascular Closure Devices were introduced in the early 1990s in an effort to reduce the time to hemostasis, enable early ambulation and improve patient comfort. Initially, devices focused on technologies involving a suture or a

collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...

plug. These technologies are effective at closing the hole; however, they often leave an intravascular component in the artery, which can cause complications. In addition, these technologies failed to accurately address patient pain. More recent methods to close the hole involve the use of novel materials that dissolve over a short period of time, such as

polyethylene glycol Polyethylene glycol (PEG; ) is a polyether compound derived from petroleum with many applications, from industrial manufacturing to medicine. PEG is also known as polyethylene oxide (PEO) or polyoxyethylene (POE), depending on its molecular we ...

found in the

Mynx vascular closure device The Mynx Vascular Closure Device is an extravascular vascular closure device (VCD) whose deployment system is designed to minimize the discomfort commonly associated with closing the small hole in the artery following catheterization procedure. T ...

. These technologies incorporate a more gentle deployment of the material to the outside of the artery and avoid the use of intravascular components, leaving nothing behind in the artery and consequently improving patient comfort.D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007)

References

* {{cite journal , vauthors=Hon LQ, Ganeshan A, Thomas SM, Warakaulle D, Jagdish J, Uberoi R , title=An overview of vascular closure devices: what every radiologist should know , journal=Eur J Radiol , volume=73 , issue=1 , pages=181–90 , date=January 2010 , pmid=19041208 , doi=10.1016/j.ejrad.2008.09.023 Implants (medicine) Interventional cardiology Interventional radiology