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Dr Tuan Phan
Dr Stuart Lyon
Date last modified: February 26, 2015
A vascular closure device is usually a piece of collagen (a fibrous protein found in skin, bone and connective tissue), metallic clip or suture (stitch) designed to provide immediate sealing of the small puncture made in an artery after an angiogram.
Angiography is the imaging of blood vessels that appear on live X-ray images or pictures. This helps show abnormalities or to guide the treatment of disease. Arterial access is commonly carried out through the femoral artery, which is a large artery running past the region of the groin. Access through this artery involves a specialist doctor puncturing the artery with a small needle through the skin and inserting a plastic sheath or tube into the artery through the puncture site.
Once the angiographic procedure is complete, the plastic sheath providing access to the femoral artery will need to be removed. This will leave behind a small hole in the artery, corresponding to the size of the plastic sheath. The hole will continue to bleed, unless treated. Stopping the flow of blood from this hole is normally achieved by manual compression with the doctor’s or nurse's fingers placed directly over the site of the hole in the artery.
Manual compression is usually very effective, but can take 10–15 minutes or longer, depending on the size of the plastic sheath placed in the artery. Manual compression requires patients to lie flat in bed with the hips in a straight position for at least 4 hours after the plastic sheath is removed.
Vascular closure devices provide an alternative to manual compression. These devices provide immediate sealing of the femoral artery access site, so there is no need for prolonged compression.
The decision to insert a vascular closure device is made by the specialist doctor carrying out your angiographic procedure. The decision can be made before commencement of the angiographic procedure, but more commonly the decision is made near or at the completion of the angiographic procedure based on many factors encountered during the procedure or as a result of the procedure.
As vascular closure devices are inserted at the end of the angiographic procedure, you will not need to do anything specifically to prepare for the device. Your preparation will be specific to the angiographic procedure itself.
When your angiographic procedure is complete, the medical staff carrying out your procedure will prepare for insertion of the vascular closure device. The device is inserted in the same room as your angiographic procedure and with you in the same position.
The plastic sheath that was placed through your skin and into your artery to provide arterial access for your angiographic procedure will be removed at the same time the vascular closure device is inserted. As the device is inserted, you may hear one or more ‘click’ sounds as various parts of the closure device are activated and released. You will need to keep still during the insertion process, but the medical staff will help you with this.
Your skin is cleaned, dried and an adhesive dressing applied. You are then transferred from the angiographic table onto a bed and moved to an observation bay.
There should be no after effects from a vascular closure device. The device should provide immediate sealing of the arterial access site. You should not be able to feel the presence of the device once it has been placed in your body. Rarely, complications do occur, which are described below.
After completion of your angiographic procedure, the preparation for insertion of the vascular closure device and the actual insertion process should take approximately 5 minutes.
In most cases, vascular closure devices work to stop bleeding from the artery immediately. Rarely, certain complications can occur. The main complications include:
If you experience any increased pain, discomfort or swelling at your groin artery access site or the corresponding leg in the hours immediately after your procedure or in the following days to weeks, you should notify or see your doctor immediately.
Vascular closure devices reduce the amount of time required for you to lie flat after your angiographic procedure. This also means that you can be discharged home earlier. The risk of immediate bleeding from the groin puncture site is also reduced.
Vascular closure devices are especially useful if you are on blood thinning medications, such as warfarin or heparin.
Certain angiographic procedures require larger punctures in your femoral artery for adequate access, such as for aortic stents. Applying manual compression to stop the bleeding after these procedures can be difficult. Vascular closure devices are useful in this situation.
Vascular closure devices are also useful in larger patients, where manual compression is difficult. Older and sicker patients may benefit from these devices, particularly if they are unable to lie flat for several hours.