Vascular Closure Devices.These devices first appeared in the 1990s as means of reducing time on bed rest and improving both hemostasis and patients’ comfort. A variety of devices seek to mechanically close the arterial puncture site during sheath removal in the catheterization laboratory in fully anticoagulated patients and shorten the time to hemostasis and ambulation.15 Three main types of vascular closure devices can be categorized by the mechanism of hemostasis, including
sutures, collagenlike plugs, and staples/clips (Figures 5-7).14,19,69 Suturemediated closure devices tie off the femoral artery with sutures. Collagen plugs seal the puncture site by stimulating platelet aggregation and the release of coagulation factors, which results in the formation of a clot. Extravascular clips or staples are used to seal off the puncture site in the artery. Hemostasis is usually obtained shortly after deployment, allowing the patient to get out of bed and ambulate faster.