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Arterial access and arteriotomy site closure devices.

Publication ,  Journal Article
Rao, SV; Stone, GW
Published in: Nat Rev Cardiol
November 2016

Arterial access and haemostasis are fundamental aspects of procedures performed in the cardiac catheterization laboratory. The first description of arterial access for cardiac catheterization was in 1948, when surgical cut-down was used to access the radial artery. Over the next 2 decades, the preferred arteriotomy method transitioned from the Sones approach of brachial artery cut-down to the Seldinger and Judkins technique of percutaneous femoral artery access. Compared with the femoral approach, percutaneous transradial access results in reduced access-site bleeding, faster time to ambulation, and greater patient comfort. Several large-scale, randomized trials have also reported a survival advantage in patients with acute coronary syndromes treated with radial compared with femoral access. However, inconsistencies exist between the completed trials, and the underlying mechanism of a reduction in mortality with radial access is uncertain. Femoral artery haemostasis can be achieved with either manual compression or vascular closure devices, with recent studies suggesting improved outcomes with the use of active closure systems. Radial artery haemostasis is achieved through the use of wristbands that mimic manual compression, and 'non-occlusive' haemostasis reduces the risk of radial artery occlusion. Newer arterial access routes and closure approaches for large-bore devices are being actively investigated. Expertise in both femoral and radial artery access and intervention is essential for contemporary interventional cardiologists.

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Published In

Nat Rev Cardiol

DOI

EISSN

1759-5010

Publication Date

November 2016

Volume

13

Issue

11

Start / End Page

641 / 650

Location

England

Related Subject Headings

  • Vascular Closure Devices
  • Radial Artery
  • Punctures
  • Patient Satisfaction
  • Humans
  • History, 20th Century
  • Hemostatic Techniques
  • Hemorrhage
  • Femoral Artery
  • Cardiovascular System & Hematology
 

Citation

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Rao, S. V., & Stone, G. W. (2016). Arterial access and arteriotomy site closure devices. Nat Rev Cardiol, 13(11), 641–650. https://doi.org/10.1038/nrcardio.2016.133
Rao, Sunil V., and Gregg W. Stone. “Arterial access and arteriotomy site closure devices.Nat Rev Cardiol 13, no. 11 (November 2016): 641–50. https://doi.org/10.1038/nrcardio.2016.133.
Rao SV, Stone GW. Arterial access and arteriotomy site closure devices. Nat Rev Cardiol. 2016 Nov;13(11):641–50.
Rao, Sunil V., and Gregg W. Stone. “Arterial access and arteriotomy site closure devices.Nat Rev Cardiol, vol. 13, no. 11, Nov. 2016, pp. 641–50. Pubmed, doi:10.1038/nrcardio.2016.133.
Rao SV, Stone GW. Arterial access and arteriotomy site closure devices. Nat Rev Cardiol. 2016 Nov;13(11):641–650.

Published In

Nat Rev Cardiol

DOI

EISSN

1759-5010

Publication Date

November 2016

Volume

13

Issue

11

Start / End Page

641 / 650

Location

England

Related Subject Headings

  • Vascular Closure Devices
  • Radial Artery
  • Punctures
  • Patient Satisfaction
  • Humans
  • History, 20th Century
  • Hemostatic Techniques
  • Hemorrhage
  • Femoral Artery
  • Cardiovascular System & Hematology