CREATED BY :

PRINSHA SANTOKI 05BM45(41)

INTRODUCTION
Increasing rate of percutaneous coronary and non-coronary interventions. Millions of people worldwide undergo a femoral artery catheterization, and other interventional procedures, such as angiography, percutaneous transluminal coronary angioplasty (PTCA), stenting , atherectomy and catheter ablation. Due to this there is strong need to stop bleeding at the puncture site without clotting in vessels as quickly as possible.

HEMOSTASIS

Physiologic process through which bleeding is halted, thusprotecting the vascular system integrity of the vascular system after tissue injury. It is responsible for minimizing blood loss. It is commonly referred to as stoppage of bleeding;

IMPORTANT FUNCTION OF HAEMOSTATIC MECHANISMS :

Maintain blood in a fluid state while circulating. Stop bleeding at the site of injury by formation of haemostatic plug . Removal of the haemostatic plug when healing is complete.

STEPS OF ACHIEVING HEMOSTASIS :

Vasoconstriction :constricts the blood vessel, minimizing vessel diameter and slowing bleeding. Platelets adheration : Platelets bind to collagen in the exposed walls of the blood vessel to form a hemostatic plug . Clotting : A complex cascade of coagulation factors, resulting in the transformation of fibrinogen into fibrin making a clot. Fibrinolysis :The clot attracts and stimulates the growth of fibroblasts within the vessel wall, and begins the repair process which ultimately results in the fibrinolysi i.e dissolution of the clot

CONVENTIONAL METHODS :
In early days hand pressure, and/or sandbags were used to stop bleeding following interventional cases. A nurse or technician holds direct manual pressure on the site until thrombus forms to seal the access site. DROWBACKS OF THESE METHODS : During these procedures patient must remain immobilized . This is monotonous and tiresome task. Due to this patients have to stay long in hospital.

HEMOSTASIS DEVICES :
TRICLIPS :

Used for initial hemostasis. It is feasible in the initial control of peptic ulcer hemorrhage.

VASCULAR HEMOSTASIS DEVICES :

FEMOSTOP : Alternative to manual compression of the femoral artery. Inflatable transparent dome with connection tubing and stopcock provides more accurate placement of pressure. Accurate manometercontrolled pressure. Less contact with blood.

SUTURE MEDIATED CLOSURE DEVICE:

Provides secure reliable Vessel closure . Provides complete tissue apposition resulting in primary healing . Provides reduced time to Hemostasis, ambulation and discharge. No re-access restrictions if previous arteriotomy repairs were achieved w/ Perclose Suture-Mediated Closure devices

Automated knot tying . Reduced procedure time. Easy deployment . Short sheath compatible with long and short wires. Hydrophilic coated straight tip sheath facilitates insertion

GUARDIAN HEMOSTASIS VALVE :

It is designed to minimize blood loss during percutaneous procedures. providing a seal around guidewires and other devices. Its signature click-open, click-close design facilitates single-handed operation.

SAFEGUARD HEMOSTASIS DEVICE :

It is a single use adhesive dressing with a transparent inflatable plastic bulb. When inflated the bulb is inelastic and provides consistent pressure over the wound site to maintain hemostasis. This device proved effective at maintainin hemostasis following femorally accessed coronary catheterization procedures adhering to wound site reliably for hours and producing no complication.

RADIO-OPAQUE AGENT DELIVERY DEVICE :

It promotes the clotting of blood at an internal wound site it includes a catheter; a delivery instrument insertable through the catheter. A radioopaque blood clotting agent that deliverable throug the delivery instrument; and a positive pressure apparatus that can dispense the blood clotting agent to the wound site through the delivery instrument.

EPICLOSE HEMOSTATE DEVICE :

The EpiClose device is most advanced solution for femoral artery closure. The deployment methodology of the device relies on balloon inflation/deflation techniques that apply selective pressure precisely over the puncture site, with the addition of an energy application stage, which accelerates hemostasis. The Epiclose device can be introduced into the vessel through most of the existing interventional- cardiology introducer sheath

ANGIO-SEAL DEVICE
It consists of three resorbable components: an anchor, a collagen sponge and a suture along with a delivery system that closes the puncture. The anchor and suture act as a pulley to position the collagen into the puncture tract adjacent to the outside of the artery wall to seal and close . This easy to use device has been used to facilitate post-procedure care in over five million patients since its commercial launch in 1996.

PROCEDURE OF USING ANGIO-SEAL:

Following the catheterization procedure, the Angio-Seal device is inserted into the femoral artery .

 The Angio-Seal device is withdraw until the anchor is seated in the artery puncture

Complete withdrawal of the device compresses the collagen sponge in the puncture tract adjacent to the outside of the artery wall to stop blood flow through the puncture. The anchor, collagen and suture are resorbed within 60-90 days after the procedure.

ACCESS CLOUSER DEVICE :

This closure device immediately seals the arteriotomy using a conformable, water-soluble, extravascular sealant that rapidly expands in the tissue tract by absorbing blood and subcutaneous fluids. As blood collects inside the sealant's matrix it clots, producing a durable hemostasis. The sealant dissolves within 30 days, leaving nothing behind but a healed artery.

VASCUSEAL :

The VascuSeal sealant technology is a patented synthetic,absorbable hydrogel delivered by a dual syringe applicator. The device can be stored at room temperature and prepared in less than two minutes.

VascuSeal sealant polymerizes within seconds when sprayed on the suture line and is blue in color which provides visualization of coverage and thickness of the material upon application. Postoperatively, VascuSeal sealant continues to seal the suture line as healing progresses under the gel. After several days, the hydrogel breaks down into water-solublemolecules that are absorbed and cleared through the kidneys.

ADVANTAGES OFHEMOSTASIS DEVICES :

It replace or augment manual compression following diagnostic catheterizations. Reduces time to hemostasis and facilitating more rapid recovery. External compression products, which include chemically-treated patches, also simplify the process of vascular closure for the clinician and staff. Reduce time in the recovery room, which contributes to better patient throughput and higher profits for catheterization labs.

DISADVANTAGES :

Complication related to infection and arterial thrombosis Another drawback is compatibility problem of these devices High coast. Limited knowledge of its use.

HOW TO GET BETTER RESULT ?

However VHD are improving, complication rates associated with their use may be decreasing, and their utilization may improve the process of care after femoral artery access.

Better understanding of the occurrence of adverse events associated with the use of vascular hemostasis devices following cardiac catheterization & further research on the subject to develop more ideal closure devices will help to overcome these problems.