Contemporary management of acute lower extremity ischemia following percutaneous coronary and cardiac interventional procedures using femoral access--a case series and discussion

[Arterial closure devices. What device for which clinical situation?]

CLINICAL/METHODICAL ISSUE

Access site complications after endovascular catheterization sometimes require open surgery and negatively impair safety, patient comfort and reimbursement. Increasing numbers of procedures and patients with multiple anticoagulants as well as cost pressure explain the demand for an immediate and stable access site closure.

STANDARD RADIOLOGICAL METHODS

Manual compression followed by compression bandage and bed rest for 4-24 h is still the gold standard but is unable to prevent access site complications in all cases.

METHODICAL INNOVATIONS

Arterial vascular closure devices allow immediate and stable closure of the puncture channel either by suture or by implantation of occluding foreign bodies or gluing fluids.

PERFORMANCE

The safety has been proven in several clinical trials. The main advantage lies in closing large lumen access sites without surgery and in patients treated with multiple anticoagulants as well as in outpatient procedures.

ACHIEVEMENTS

They have become a valuable supplement to the interventional arsenal.

PRACTICAL RECOMMENDATIONS

The physician, however, has to decide between different systems and mechanisms with respect to patient constitution, selected access vessel and level of calcification and diameter. Furthermore, all systems require a defined training prior the first use.