SAH Vasospasm Endovascular Treatment
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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:
Device failure (less than 6% of cases). This requires immediate management by firm compression with a finger on the bleeding site. A doctor or nurse will do this. If this problem occurs, blood loss may be greater than if no closure device had been used, particularly if you are on blood thinning medications.
Delayed bleeding (2.5-5% of cases). This is about the same compared to simple firm compression of the puncture site for several minutes with a finger. If bleeding is small enough to be unrecognised at the time of inserting the closure device, a small collection of blood can form immediately outside the artery. This is known as a pseudoaneurysm, which can clot spontaneously and either resolve itself or persist, and be at risk of rupture and further bleeding.
The closure device can act as an obstructing foreign body within the artery, limiting blood flow down the leg (less than 1% of cases).
Infection (less than 1% of cases). Vascular closure devices all leave foreign bodies within the artery and/or surrounding soft tissues. Foreign bodies increase the risk of infection, which usually becomes apparent approximately 1 week after the procedure.
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.
The doctor carrying out your angiographic procedure will be responsible for using the vascular closure device. The doctor will be a specialist in the field, and may be an interventional radiologist or vascular surgeon.
Vascular closure devices are used at the end of angiographic or vascular procedures. Such procedures are carried out in an angiography suite or an operating theatre, in a hospital or private radiology practice.
Vascular closure devices are successful at stopping bleeding at the groin puncture site in almost all cases. Rarely, a few minutes of manual compression may be required because of bleeding from veins or blood vessels near the skin surface. In most cases, you will be able to sit up and walk in 60-120 minutes after insertion of the vascular closure device and be discharged home in 2-4 hours.
These results can vary greatly depending on the nature of the angiographic procedure for which the vascular closure device was inserted and your underlying medical illnesses.
Page last modified on 26/7/2017.
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