Peripheral Vascular Disease
Vascular Closure Device
The benefits of needle sticks versus large incisions include shorter operations, shorter hospital stays, less pain, and fewer bleeding risks. Unfortunately, it does not avoid all complications. The vascular access-site, where the needle punctures the artery, is the main focus of these complications which can include things like bleeding, arterial wall ballooning (pseudoaneurysm), and separation of the layers of the arterial wall (dissection).
Historically, manual compression over the needle stick site has been the gold standard. It requires reversing or stopping anticoagulation, a prolonged bed rest, prolonged time to discharge, and can be uncomfortable for patients. Therefore, vascular closure devices have been developed as specific technology to improve on these limitations. These were introduced in the 1990’s and have several categories based on how they work. Examples are injecting pro-clotting agents, plugs, suture devices, or even clips.
Percutaneous Arterial Access
Management of PVD was once limited exclusively to open procedures that included large incisions, coring plaques out of arteries (endarterectomy), and bypasses of blocked areas. Around 1960, Sven Seldinger introduced his technique to access vessels with a hollow needle and wire, and from this, multiple minimally invasive innovations blossomed.
These techniques have created a window of opportunity for earlier identification of disease severity and potential interventions such as stents, grafts, and balloon dilations (angioplasty) of plaques. These are termed percutaneous procedures. These minimally invasive percutaneous procedures are often outpatient and offer less morbidity than larger, more invasive procedures.
Peripheral Vascular Disease
Vascular disease is the most common cause of sickness of any group of human diseases and occurs throughout the entire body, including the heart (coronary artery disease), brain (cerebrovascular disease), and even the extremities (peripheral vascular disease, PVD).
In the extremities, the most common cause is atherosclerosis, a buildup of plaque within the arterial wall that restricts blood flow. Certainly, there are many risk factors for atherosclerosis such has high cholesterol, high blood pressure, diabetes, and tobacco use, all of which are potentially modifiable.
In fact, most of the population in the West will be using medications to lessen these risk factors. Often, the progression of the disease cannot be stopped by medicine alone and leads to chronic pain, wounds, and eventually limb loss. A physical exam and ultrasound imaging can typically be done to diagnose the disease and give an idea of its severity. When the complications mentioned above begin to occur, typically surgery becomes an important factor in curbing the disease process and helping patients return to their normal life.
PerClose Proglide system is a vascular closure device that avoids an open incision and dissection down to the artery. It falls in the category of suture mediated percutaneous closure devices. The device uses a suture (polypropylene monofilament) with a preformed knot that is advanced down to the arterial wall and approximates the edges of the hole in the artery(arteriotomy), allowing for hemostasis and primary healing while providing reinforcement. It can be used for large-bore vessel closures and multiple devices can be deployed depending on the arteriotomy size.
Its advantages to the gold standard of manual pressure are improved patient comfort, shorter time to hemostasis, earlier post-procedural ambulation, earlier discharge, and less time required from hospital staff.