What ’ s on the market , and what ’ s in the pipeline

T he description of the Seldinger technique in 1953 created a novel problem—physicians were creating holes in the common femoral artery that now needed to be closed. The first, and still gold standard, method for addressing this problem was the use of manual compression. As the holes got bigger and constraints on physicians’ time became greater, novel solutions to this problem began to emerge. The vascular closure device (VCD) market has grown exponentially since its inception in the early 1990s. Global estimates for the market in 2013 approach $1 billion; this growth reflects several factors. The use of manual compression may be of limited utility in obese patients or patients on anticoagulation, and the complexity of procedures performed with a percutaneous endovascular approach has grown, often with an associated increase in sheath size. In such situations, the ability for manual compression to achieve hemostasis may be decreased. As the economic landscape of health care becomes more competitive, VCDs are becoming increasingly valuable because their use can free up medical personnel for other responsibilities. Early ambulation and improved comfort also boost patient satisfaction—an increasingly monitored metric. This article is an update of a previous review of VCDs,1 beginning with a review of the recent literature and trends in VCD development. The Society of Interventional Radiology quality improvement guidelines for the use of VCDs will be referenced.2 Later, concepts of VCDs will be revisited, and the most popular VCDs will be discussed. A more thorough list, with brief description, is presented in Table 1.