Closure Device, Vascular (Implantable/Insertable) (C1760)

Name of the Procedure:

• Common Names: Vascular closure device, arterial closure device
• Technical Terms: Percutaneous vascular closure, percutaneous arterial closure

Summary

A vascular closure device is a medical implant used to seal a puncture site in a blood vessel, commonly after a catheterization or other vascular procedure. It helps ensure proper healing and reduces bleeding complications.

Purpose

• Medical Conditions: Used primarily after procedures like angiography or angioplasty where a catheter is inserted into a blood vessel.
• Goals: To achieve immediate hemostasis (stopping of bleeding) at the vascular access site, reduce the risk of bleeding, and facilitate quicker patient recovery and mobilization.

Indications

• Symptoms: Bleeding or potential bleeding from a vascular access site.
• Conditions: After vascular procedures such as cardiac catheterization or endovascular interventions.
• Patient Criteria: Patients who have undergone such interventions and need a reliable method to close the puncture site.

Preparation

• Instructions: Patients may need to fast for a certain period before the procedure and avoid certain medications that affect blood clotting.
• Diagnostic Tests: Blood tests to assess clotting ability and pre-procedural imaging to plan the access site.

Procedure Description

1. Preparation: The insertion site is cleaned and prepared under sterile conditions.
2. Insertion: After the vascular procedure, the vascular closure device is guided to the puncture site via the existing catheter.
3. Activation: The device is activated to seal the puncture. It may use collagen plugs, sutures, or other mechanisms depending on the device.
4. Removal: The introducer sheath is carefully removed, leaving the closure device in place.
   • Equipment: Vascular closure device kit, catheters, introducers, and imaging tools (e.g., fluoroscopy).
   • Anesthesia: Local anesthesia is typically used.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

Usually performed in a hospital setting, such as a catheterization lab or an outpatient surgical center.

Personnel

• Healthcare Professionals Involved: Interventional radiologists, cardiologists, vascular surgeons, nurses, and sometimes an anesthesiologist.

Risks and Complications

• Common Risks: Minor bleeding, hematoma (bruising), site infection.
• Rare Risks: Device failure, deep vein thrombosis, arterial damage, embolism.
• Management: Healthcare providers monitor for complications and can intervene with medications, additional procedures, or supportive care as needed.

Benefits

• Expected Benefits: Immediate hemostasis, reduced hospital stay, quicker patient ambulation, and lower risk of bleeding complications.
• Timeline: Benefits are often realized immediately, with patients typically able to mobilize within hours.

Recovery

• Post-procedure Care: Keep the insertion site clean and dry, monitor for signs of infection or complications.
• Recovery Time: Most patients can return to normal activities within 1 to 2 days, with specific instructions based on individual cases.
• Follow-up: Follow-up appointments may be scheduled to ensure proper healing.

Alternatives

• Treatment Options: Manual compression, mechanical compression devices, sutures.
• Pros and Cons: Manual compression is simple but time-intensive and uncomfortable; mechanical devices are less invasive but may be less reliable than closure devices.

Patient Experience

• During the Procedure: Patients might feel slight pressure but typically experience minimal discomfort due to local anesthesia.
• After the Procedure: Mild soreness or bruising at the site; pain management includes over-the-counter pain relievers as advised by healthcare providers.
• Comfort Measures: Patients should report any severe pain, swelling, or other unusual symptoms to their healthcare team immediately for assessment and management.