Access and Closure

  • Ahmad M. Thabet
  • I. Paul SinghEmail author


When addressing endovascular procedures, complication avoidance is often aimed at the critical portions of a procedure where the risk for a catastrophic outcome is the highest, for example, when deploying a framing coil in a ruptured aneurysm or delivering a liquid embolic to a potential area of eloquent cortex adjacent to an AVM. A perfectly framed aneurysm can be a satisfying result for both the interventionalist and the patient, but this success is easily belittled when access site complications occur at the beginning or end of an endovascular procedure. Formidable complications, such as the loss of a limb, or even the need for unplanned rescue procedures or surgeries required to treat the complications, are avoidable with prudent preparation from the interventionalist. This chapter will address complication avoidance in arteriotomy site access and closure, as well as management when these unfortunate outcomes manifest.


  1. 1.
    Lee DH, et al. Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety. Br J Radiol. 2004;77(922):831–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Levy EI, et al. Transradial cerebral angiography: an alternative route. Neurosurgery. 2002;51(2):335–40. Discussion 340–2.CrossRefPubMedGoogle Scholar
  3. 3.
    Nohara AM, Kallmes DF. Transradial cerebral angiography: technique and outcomes. AJNR Am J Neuroradiol. 2003;24(6):1247–50.PubMedGoogle Scholar
  4. 4.
    Amin FR, et al. Femoral haemostasis after transcatheter therapeutic intervention: a prospective randomised study of the angio-seal device vs. the femostop device. Int J Cardiol. 2000;76(2–3):235–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Biancari F, et al. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010;159(4):518–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Cremonesi A, et al. Femoral arterial hemostasis using the angio-seal feminine system after coronary and vascular percutaneous angioplasty and stenting. J Invasive Cardiol. 1998;10(8):464–9.PubMedGoogle Scholar
  7. 7.
    Das R, et al. Arterial closure devices versus manual compression for femoral haemostasis in interventional radiological procedures: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2011;34(4):723–38.CrossRefPubMedGoogle Scholar
  8. 8.
    Kapadia SR, et al. The 6Fr Angio-Seal arterial closure device: results from a multimember prospective registry. Am J Cardiol. 2001;87(6):789–91, A8.CrossRefPubMedGoogle Scholar
  9. 9.
    Kussmaul WG III, et al. Rapid arterial hemostasis and decreased access site complications after cardiac catheterization and angioplasty: results of a randomized trial of a novel hemostatic device. J Am Coll Cardiol. 1995;25(7):1685–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Nikolsky E, et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol. 2004;44(6):1200–9.PubMedGoogle Scholar
  11. 11.
    Pollard SD, et al. Position and Mobilisation Post-Angiography Study (PAMPAS): a comparison of 4.5 hours and 2.5 hours bed rest. Heart. 2003;89(4):447–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schickel SI, et al. Achieving femoral artery hemostasis after cardiac catheterization: a comparison of methods. Am J Crit Care. 1999;8(6):406–9.PubMedGoogle Scholar
  13. 13.
    Wu PJ, et al. Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis. BMC Cardiovasc Disord. 2015;15:34.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cox N, Resnic FS, Popma JJ, et al. Managing the femoral artery in coronary angiography. Heart Lung Circ. 2008;17(Suppl.4):S65–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Deshaies EM, Eddleman CS, et al. Handbook of neuroendovascular surgery: Chapter 10. Endovascular complications.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryWestchester Medical Center/New York Medical CollegeValhallaUSA
  2. 2.Departments of Neurosurgery, Neurology, and RadiologyMount Sinai HospitalNew YorkUSA

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