Manual, Mechanical, and Device Hemostasis

Optimal management of vascular access sites to assure hemostasis while minimizing the risk of vascular injury or complication has been a primary challenge of all endovascular techniques. While manual compression of the arterial access site had been the standard approach to hemostasis for many procedures, tools and techniques for mechanical compression and the development of implantable vascular closure devices now provide a variety of options for the management of vascular access sites. Given the many options for vascular access site management, it is encumbant on the endovascular expert to incorporate available evidence, as well as their own experience and expertise, in the selection of a access site management strategy. In this chapter, we review the evidence for the use of various vascular access site management techniques including manual compression, mechanical compression and vascular closure devices, and explore the unique advantages and disadvantages of each approach.