The Essentials of Femoral Vascular Access and Closure

Best practices for vascular arterial access and closure: a contemporary guide for the cardiac catheterization laboratory

“…Historically, manual compression has been the standard of care for achieving hemostasis following femoral arterial sheath removal, usually once activated clotting time (ACT) has been less than160–180 s ( 96 ). Given the labor intensive nature of digital compression by catheterization laboratory staff members, a number of mechanical compression devices, such as the Femostop (Radi Medical System) and CompressAR C-clamp (Advanced Vascular Dynamics) were subsequently developed, with some studies suggesting that they may be associated with reduced vascular complications compared with manual hold ( 97 – 99 ).…”

“…In response to the logistical challenges associated with manual pressure and passive closure platforms, a variety of vascular devices (VCD) have been developed since the mid 1990s which can be deployed at the conclusion of cardiac catheterization, allowing for potentially faster hemostasis, shorter duration of bed rest and reductions in patient discomfort ( 96 ). They are used in up to 75% of TFA cases in contemporary clinical practice ( 100 ).…”

“…The Angio-Seal system (Terumo, Somerset, NJ) is one of the most commonly used platforms in the United States, consisting of a co-polymer which is deployed intravascularly and attached by an absorbable Dexon traction suture to an extravascular collagen plug ( 96 ). It was first studied against manual compression in a multi-center RCT of 435 patients undergoing cardiac catheterization and was noted to have 85% reduction in time to hemostasis and lower rates of bleeding and hematomas ( 109 ).…”

“…Once the return of pulsatile blood is noted from the side arm, the device lever is pulled and two simultaneous needles are deployed through the anterior wall of the femoral artery utilizing the non-biodegradable polypropylene microfilament with preformed knot that is tightened to form the suture loop. The suture is then retracted to the anterior wall of the arteriotomy site and deployed to achieve hemostasis ( 96 ) ( Figure 4 ). The Perclose platform is unique among VCDs as it maintains access to the vessel by way of the 0.035 inch guidewire after the needles and suture have been deployed.…”

“…A collagen-based platform, it is currently available in 14 Fr and 18 Fr configurations, and it is 0.035″ guidewire compatible, consisting of a poly-lactic-co-glycolic snap attached to a bovine collagen plug which is tampered down, sandwiching the arteriotomy while a toggle is deployed intravascularly. The toggle and collagen plug usually are fully absorbed within 6 months and the vessel may be re-accessed 2.5 cm cranial or caudal to the MANTA device ( 96 ). The safety and efficacy of MANTA was recently compared with Proglide in the Randomized Comparison of Catheter-based Strategies for Interventional Access Site Closure during Transfemoral Transcatheter Aortic Valve Implantation (CHOICE-CLOSURE) study, a multi-center RCT of 516 patients undergoing TAVR ( 115 ).…”