Overview of Femoral Vascular Closure Devices After Catheterization Procedure
Cardiac catheterization is a medical procedure needed for several heart-related treatments like clearing blocked heart arteries, opening up narrow heart valves, treating irregular heart rhythms, and fixing certain birth heart defects. This procedure is important to help identify and manage conditions like heart attacks, heart diseases, valve problems, or birth heart defects. It’s done quite often in the aspect of heart medicine that uses tubes called catheters to treat heart conditions. One of the usual ways this procedure is done is by inserting the catheter into an artery in the thigh area called the femoral artery.
After the procedure, it’s crucial to properly close the spot where the catheter entered the femoral artery. Therefore, the need for devices that help in closing the femoral artery keeps growing.
In the beginning, the only way to stop bleeding from the spot where the catheter was inserted was through putting pressure on the femoral artery. While this method is okay for patients without other health conditions, it can be difficult for patients who are obese and taking blood-thinning medicines. Also, patients treated through the femoral artery usually have to stay longer in the hospital than those treated through the wrist artery. Putting pressure manually would take a longer time to stop the bleeding, thereby adding more pressure on the healthcare system. Some procedures like the insertion of heart pump devices and heart valve replacements require relatively larger access points on the femoral artery, making it tougher or less effective to stop the bleeding through physical pressure.
Devices used for closing the femoral artery fall into two classes. They can either be classed as passive or active. Passive closure devices work by putting pressure or by increasing clot formation for effective bleeding control. However, passive devices do not speed up the actual time it takes to stop the bleeding. On the other hand, active closure devices such as stitches, collagen plugs, and clips can be used.
Anatomy and Physiology of Femoral Vascular Closure Devices After Catheterization Procedure
The femoral artery is a major artery found in the lower part of your body, specifically in your leg. If you’ve ever heard of a test called a cardiac catheterization, this is the usual spot that doctors will make use of to carry out the test. The femoral artery is an extension of another artery, called the external iliac, which directly connects to the largest artery in your body, the abdominal aorta.
There’s a bit of your body right at the hip area, called the inguinal ligament, where the femoral artery starts its course. Right underneath this ligament and within an area called the femoral triangle, the femoral artery breaks into two sections: the superficial and deep femoral arteries. The superficial femoral artery travels further into your leg and becomes another artery called the popliteal artery. On the other hand, the deep femoral artery almost immediately splits into the medial and lateral circumflex femoral arteries.
In the femoral triangle, the arrangement of the femoral artery and other major structures is important to understand. From the outside to the inside, these include the femoral nerve, the femoral artery, the femoral vein, the femoral canal, and the deep inguinal nodes. A thin sleeve of connective tissue called the femoral sheath wraps around the femoral artery and vein. This organization matters because if a device needs to be inserted into the femoral artery, this layout can help to avoid complications.
Why do People Need Femoral Vascular Closure Devices After Catheterization Procedure
A femoral vascular closure device is used to stop bleeding by successfully sealing up the hole made in the femoral artery, which is a major blood vessel in the leg. It also helps to reduce the time it takes to completely stop the bleeding. This device is often used in procedures involving big entry points to the body’s structure to promptly stop any bleeding.
When a Person Should Avoid Femoral Vascular Closure Devices After Catheterization Procedure
Newer devices used for the blood vessels in the thigh (femoral vascular devices) are still being studied and developed. Due to this, there aren’t specific reasons why they shouldn’t be used, but there are concerns and situations when they may not be the right choice.
Here are some issues with the place where the device is used (access site) that could make these thigh blood vessel devices less suitable:
* If the place where the device is inserted is above the ligament in your groin (inguinal ligament).
* If the device is inserted through the arteries that are near the surface or deeper in your thigh (superficial or deep femoral arteries).
* If the device is inserted from the side of the artery wall.
* If a doctor had to try many times to find a spot to insert the device in any part of the artery.
* If there’s a bacterial infection around the place where the device is inserted.
* If there’s a lot of hardening from calcium (heavy calcification) in the area where the device is inserted.
Also, in the following health situations, doctors need to be extra careful when considering the use of these devices:
* If you’re taking a blood-thinner called warfarin.
* If you’re having a treatment to dissolve blood clots (thrombolysis).
* If you have a medical condition that makes you bleed easily (bleeding diathesis).
* If you have a disease affecting the blood vessels in your arms or legs (peripheral vascular disease).
Equipment used for Femoral Vascular Closure Devices After Catheterization Procedure
The items needed to effectively perform a femoral artery closure, which involves closing a blood vessel in the thigh, are as follows:
- Sterile gloves and drapes: Protective clothing and coverings to ensure a clean, germ-free surgical environment.
- Ultrasound machine: A device that uses sound waves to create images; in this case, to visualize the femoral artery.
- Local anesthesia (Lidocaine), syringes, and needles: Lidocaine is a drug used to numb the area around the surgical site. Syringes and needles are the tools used to administer this medication.
- 4 x 4 gauze: Small cloth pads used to absorb fluids or pack wounds.
- Chlorhexidine: A disinfectant used to clean the skin before surgery.
- Short and long J-tip wires: These are wires with a J-shaped tip, which help guide other instruments or devices into the right place in the body.
- Tegaderm: A clear adhesive film dressing that protects the wound and allows it to be observed without removing the dressings.
- Specialized vascular closure devices kits: A package with all the specific tools needed for closing blood vessels.
Though some components may vary, most of these kits generally include the following:
- Insertion sheath: A tubular structure through which the surgical instruments can safely be inserted into the body.
- Arteriotomy locator (modified dilator): A special tool used to locate the site where the artery was opened (arteriotomy).
- 6 French or 8 French with J-tip guide wire: This is a measurement of the size of the diameter of the guide wire; a higher French number indicates a larger wire.
- Vascular closure device: A device used to seal the puncture in the blood vessel after surgery is completed.
Who is needed to perform Femoral Vascular Closure Devices After Catheterization Procedure?
The team required for placing a device to close up your blood vessel in your thigh (femoral vascular closure device placement) is usually composed of a few special medical professionals. An interventional cardiologist, who is a heart doctor, leads the procedure. They are assisted by a radiology technician, a person trained in producing and processing medical images like X-rays, and various nurses who provide additional support.
There might also be some other helpers, called first assistants. These could be physician assistants (medical professionals who work under the supervision of a doctor), residents (doctors gaining practical experience), or fellows (doctors receiving advanced medical training). They all work together to ensure your procedure goes smoothly and safely.
Preparing for Femoral Vascular Closure Devices After Catheterization Procedure
Before starting a process known as catheterization, the medical team has to thoroughly wash and put on sterilized outfits and gloves. Catheterization involves inserting a thin, flexible tube into a blood vessel to help with certain medical procedures. This typically starts with feeling the pulse in the leg, especially at places where major arteries are located like behind the knee, near the ankle, and on the top of the foot.
When applying a device designed to close the blood vessel in the leg, it’s usually done at the start of the procedure if a large hole was made, or right after the catheterization is finished. It’s important to keep the insertion site as clean as possible, and this is done by using sterile covers around it. The doctors often use ultrasound, which is a tool that uses sound waves to create pictures of the inside of the body, and a type of x-ray called fluoroscopy to guide them in what they are doing.
How is Femoral Vascular Closure Devices After Catheterization Procedure performed
Before we discuss the various types of femoral vascular closure devices, it’s important to understand mechanical compression. This is a standard method used to stop bleeding after a procedure that involves inserting a catheter into a blood vessel. If other devices fail to stop the bleeding, doctors often resort to this technique. After certain procedures are done, the sheath (a protective tube) is left in place for a while so that any blood in the area can clot. After the sheath has been taken out, pressure is applied to the site for a certain amount of time. If bleeding persists, additional pressure is applied for longer. Afterwards, a bandage is applied and the patient must rest in bed for at least eight hours to allow everything to heal.
Femoral vascular closure devices, which help to stop bleeding and close the vessel after procedures, can be divided broadly into two types: passive and active devices.
Passive devices can be either a device that clamps a pad down on the puncture site to apply pressure, much like a doctor or nurse would do with their hands, or a kind of belt that applies pressure to the area. There are also special pads that help to speed up the clotting process. However, studies show that these aren’t necessarily better than a nurse or doctor applying pressure.
Active devices work slightly differently. One kind of active device is the collapsible disc with a coating that helps promote clotting. This device is inserted into the sheath that’s already there from the procedure. Once it’s in place, part of the device pulls back to create a disc inside the vessel, somewhat like opening an umbrella. Once the disc is open, the catheter can be taken out. The doctor then pulls on the device to ensure the disc is pressing against the wall of the vessel, temporarily blocking the puncture. They then use special imaging to make sure the disc is in the right place. After this, the doctor removes a sleeve from the device to expose the area to substances that help to reverse the local effects of a common blood-thinner and speed up healing. The disc is then taken down and the device taken out. After this, pressure is still applied to the area for a handful of minutes.
Another type of active device uses a collagen plug. It works in a similar way to the first device, but after the sleeve is taken off, a collagen patch is left in the tissue in the area to help with healing and clotting. There’s another version of this device that has a tip coated with a certain substance that lines the inside of the artery to help stop bleeding.
Other active devices use either a special type of acid or a clip at the site to help stop the bleeding. Last but not least, there is a device that uses sutures (special medical threads) to close the site. Unlike the other devices, sutures do not use an existing catheter. Instead, they go directly into the site with the help of a guidewire. This device uses techniques such as needles, sutures, and even a footplate that helps hold everything in place. Once the sutures are in, they are tied and then pushed towards the site.
Possible Complications of Femoral Vascular Closure Devices After Catheterization Procedure
Using devices to close off certain areas in the femur (thigh bone) can sometimes lead to complications. One of the most common problems is getting an infection in the groin area. Therefore, it’s super important that these devices are placed in a very clean environment using the right dress and covering. Infections particularly happen more often in blood vessel devices compared to just simply applying pressure to stop bleeding.
Another potential problem is a condition called ischemia. This happens when blood flow to areas further away from where the closure device is placed is reduced or blocked, usually due to blood clots or particles that block small arteries. This is why doctors typically avoid placing closure devices in areas of an artery that are heavily filled with calcium deposits. This type of problem is more common when closure devices are used compared to just applying pressure.
Other issues that can arise include bleeding, severe bleeding (also known as hemorrhage), and the formation of false aneurysms – which are blood-filled sacs that look like blisters on the blood vessel wall. These complications are, however, more likely to happen with manual pressure as compared to vascular closure devices.
Often, if these complications occur, a surgery might be necessary to deal with them. This surgery might involve rerouting blood flow using a graft, which is a piece of healthy blood vessel taken from another part of the body to replace the diseased or damaged section.
What Else Should I Know About Femoral Vascular Closure Devices After Catheterization Procedure?
As more and more people are needing a medical procedure called a catheterization, doctors are realizing just how important it is to manage the entry point into the artery properly. Catheterization involves inserting a thin tube into an artery, and needs to be done carefully.
Although many different types of tools or ‘vascular closure devices’ exist to help seal the artery after the procedure, the traditional method of applying pressure by hand is still the trusted go-to technique. Interestingly, studies have shown there isn’t a big difference in the patient’s healing process between these innovative tools and the hands-on approach. However, these devices can help stop bleeding and get patients moving sooner after the procedure.
So, it’s important for heart specialists and vascular surgeons to familiarise themselves with these devices. They need to understand the benefits and risks of using them on different kinds of patients to ensure they can make the best decision for each individual case.
