Vascular Access Techniques and Closure Devices


Although noninvasive imaging technologies have advanced significantly, invasive angiography remains the gold standard for diagnosis of a number of vascular pathologies. Minimally invasive therapy provided through transarterial and transvenous routes continues to increase for a variety of disease processes including cancer therapy, neurovascular pathology, atherosclerotic vascular disease, congenital vascular malformations, thrombosis, and management of active hemorrhage. Arterial access methods continue to progress by using nonstandard access vessels with a goal to improve patient safety, comfort, and facilitate procedural technical success. Venous interventions are varied and include thrombo-occlusive disease management, venoplasty, and venous access. Complex venous access techniques are often necessary for patients requiring a chronic central venous access. Several arterial access closure devices are currently available for use. Each device utilizes a unique mechanism to obtain hemostasis with a goal of diminishing post-procedural bleeding and reducing procedure time. Patient-specific risk factors and method of hemostasis should be considered to reduce bleeding risk.

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Bishay VL, Ingber RB, O’Connor PJ, Fischman AM. In: IR Playbook, 2018.