Femoral Vascular Closure Devices After Catheterization Procedure

Excerpt

Cardiac catheterization is often required for various procedures, including angiography, angioplasty, valve replacement, valvuloplasty, ablation, and congenital heart repair. This procedure is necessary to assess and care for many patients presenting with myocardial infarction, heart disease, valvular disease, or congenital heart disease—with a common site of catheterization entry being the femoral artery. Catheterization is a procedure that is heavily performed in the field of interventional cardiology. After catheterization procedures, appropriate mechanisms are necessary to close the port of entry of the catheter into the femoral artery. As a result, the need for devices to assist in closing the femoral artery is continually evolving.

Initially, the only mechanism to assist in hemostasis at the catheter insertion site would be mechanical compression of the femoral artery. Although mechanical compression is sufficient in patients without certain comorbidities, it can be challenging in patients who are obese and on anticoagulation therapy. Additionally, patients treated through femoral access require a longer hospital stay than those who receive radial access. Manual compression would take longer to achieve hemostasis, increasing the strain on the healthcare system. Certain procedures, such as inserting left ventricular assist devices and mitral/aortic valve replacement procedures, require larger femoral vascular access sites, making mechanical compression cumbersome or a less effective method to achieve hemostasis.

Femoral vascular closure devices can be divided into 2 broad categories: passive and active. Passive closure devices help achieve mechanical compression and reduce thrombosis to achieve effective hemostasis. However, passive devices do not hasten the time it takes to reach hemostasis. Active closure devices include suture devices, collagen plugs, and clips.