Which of the following indicate arterial closure device failure?

• A. Diminished pulses to the extremity and presence of hematoma at the access site
• B. Normal pulses
• C. No bleeding at the access site
• D. Pain at the access site that resolves quickly

Answer: (A)

Arterial closure devices are used to seal the puncture site after arterial access, and when they don’t work properly, the most telling sign is impaired blood flow to the limb along with bleeding into surrounding tissues. Diminished pulses beyond the access point indicate reduced perfusion to the extremity, which can happen if the device fails to seal the artery, causes an occlusion, or if a hematoma forms that compresses the vessel. The presence of a hematoma at the access site shows continued bleeding and vessel wall disruption, reinforcing that the closure device did not achieve effective hemostasis. Together, these findings point to a closure device failure.

Normal pulses suggest preserved limb perfusion, so not a failure. No bleeding at the access site implies successful closure. Pain at the access site that resolves quickly is common post-procedure discomfort and does not by itself indicate device failure.