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Closure devices for femoral punctures
  1. Iqbal Malik
  1. Dr I Malik, Imperial College Healthcare NHS Trust, St Mary's Hospital Campus, Praed Street, London W2 1NY, UK; i.malik{at}imperial.ac.uk

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Although the use of radial arterial access is slowly increasing, the majority of percutaneous coronary and non-coronary interventions use the femoral artery as the site of entry. I will ignore the use of the brachial artery since cut-down techniques are a dying art form, and percutaneous brachial puncture has an unacceptable complication rate. Apart from reasons of familiarity and training, there are several good reasons to maintain the “old” skill of femoral access. The ability to upscale to larger catheter sizes for more complex interventions such as carotid and thoracic stenting, and the use of some types of thrombus extraction devices needing 7F and 8F sheaths, maintain the need for femoral access for the present. Imaging of venous and arterial bypasses to the coronary arteries is also often more easily done from the leg than the arm. In the future, device implantation for paravalvular leaks and percutaneous valves, both needing large access sites, may gain favour, and are unlikely to be achievable from smaller arteries such as the radial.

However, the reason for the growth of radial access is its twofold ability to allow mobilisation of patients more rapidly and reduction of the risk of access-site complications. Have devices that close the hole in the femoral artery matched either of these benefits?

The three main types of devices used are a suture (Perclose; Abbott Vascular, Illinois, USA), an intravascular plug (Angioseal; St Jude Medical, Minnesota, USA) or a metal …

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