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Interventional Cardiology


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+ + Manta Essential Medical + + Suture devices ProGlide Abbott + + ProStar Abbott + + Staples/clips StarClose Abbott + + Angiolink Medtronic + + Liquid/gel Duett Vascular Solutions + + Mynx Access Closure + + FISH Morris Innovative – +

      As a general rule, endorsed by an AHA consensus of experts [25], in all patients considered for a vascular closure device a femoral angiogram should be performed in order to assess the anatomic suitability for its use (puncture site, vessel diameter, atherosclerosis, calcification, etc). The use of vascular closure devices is generally discouraged if the diameter of the common femoral artery is less than 6 mm or if the arterial sheath entry is located below the femoral artery bifurcation or above the inferior hypogastric artery.

      AngioSeal

      The AngioSeal device consists of a rectangular absorbable copolymeric anchor deployed intravascularly against the arterial wall which is attached by an absorbable Dexon traction suture to an extravascular collagen plug applied to the outside of the arterial wall. The AngioSeal assembly consists of a carrier system with the anchor, collagen plug, and traction suture compacted at the distal end. There is a delivery sheath with a modified locator dilator which identifies when the sheath is intravascular. After cardiac catheterization, the working sheath is changed over to the AngioSeal delivery sheath. Once the delivery sheath is intravascular, as indicated by pulsatile flow in the arteriotomy locator system of the dilator, the dilator and wire are removed. The carrier is then advanced into the sheath, locks in place with the sheath, and then the entire assembly is withdrawn until resistance is felt. This indicates apposition of the anchor on the luminal arterial wall. Further withdrawal releases the collagen plug on the external surface of the artery, followed by a tamper tube. The tamper tube is used to compress the plug over the wire, followed by removal of the tamper tube and cutting of the suture, which are external to the patient. Currently, the AngioSeal is available in two sizes: 6 and 8 Fr. Deployment success rates ranged from 92% to 98%, and hemostasis success ranged from 84% to 97% [26].

      Perclose

Schematic illustration of the Perclose ProGlide device is used to deliver sutures through the puncture to close the arteriotomy site.

      StarClose