C-64 | Active Closure-A safer way to close.

VCD’s decrease time to ambulation, increase patient comfort and decrease vascular complication rates compared to manual compression. VCD failure occurs in 2-9 % of cases. When VCD’s fail, rates of severe complications increase. Arteriotomy closure is generally a blind process being directed by a sheath angiogram or no visualization at all. Ultrasound assisted access has been shown to decrease inappropriate sticks and complication rates. We use ultrasound to assist in “active closure” as well. Under direct ultrasonic visualization the VCD is seen to be in the correct position with the base element against the arteriotomy before the device is deployed. In cases where the device becomes entangled in intravascular structures it is maneuvered under ultrasound into a safe position for deployment. From 6/22-12/23 all non-radial/pedal access cases were followed. Ultrasound access, usually in long axis was used in all cases and ultrasound directed active closure in 193 of 194 cases. When necessary, the device was manipulated using real time ultrasound to avoid entanglements and achieve an optimal position of the footplate against the arteriotomy for deployment. We made note of hostile closure anatomy defined as more than 40% obstruction in the closure path. Patients were followed clinically in this largely outpatient registry. Those with complaints or issues on exam were evaluated. 193 of 194 cases were closed with a VCD. 180/194 were fully anticoagulated. 129 PTA’s, 49 PCI’s. 15 large bore (>than 6 french). 12 antegrade closures.2 brachial closures. 184 Collagen based devices, 8 suture mediated, 1 vascade. 25 access sites had > 40% disease in the closure tract. Of those 25, 15 required additional manipulation of the VCD for safe deployment. In 11 other cases devices required additional manipulation even though the disease in tract appeared modest. There were no deaths or vascular closures, no ischemic limbs, 1 device failure closed manually, 3 late PSA’s required thrombin injection and one hospitalization for transfusion. Ultrasound directed active closure is a technique that is generally safe and may decrease the risk of device failure as well as access artery complications.