ABSTRACT
The percutaneous treatment of coronary artery disease has constantly expanded during the last two decades. Vascular access for percutaneous coronary interventions is usually obtained through the common or superficial femoral artery, employing introducer sheaths of various sizes in order to enable the positioning of different types of catheters in the coronary tree. Interventional procedures may require the use of larger sheaths than pure diagnostic procedures. Furthermore, the use of heparin and new antithrombotic agents (especially glycoprotein IIb/IIIa antagonists) during percutaneous transluminal coronary angioplasty (PTCA) makes the achievement of immediate hemostasis at the arterial puncture site challenging. Some other clinical situations, such as hypertension, aortic insufficiency, intraaortic balloon pumping, and new circulatory assist devices that require the use of large sheaths, need adequate hemostasis at the arterial puncture site. For these patients, manual or mechanical compression was until recently the only way to control bleeding, by allowing clot formation at the arterial access site. The duration of manual compression as well as the time of immobilization were in general proportional to the size of the introducer sheath and the level of anticoagulation. Manual compression techniques are in general effective with the small sheath sizes used in diagnostic procedures. However, with the employment of larger sheath sizes, prolonged surveillance time and bed rest has to be maintained.
