A medical device for creating and closing an opening through a vessel wall is described. The device includes a guiding engagement element positioned in a vessel wall an incising member positionable over the engagement element and a cutting element, with a recessed notch, at a distal end of the incising member. The cutting element forms a flap on a first portion of a vessel wall, the flap having a first portion attached to the wall and second portion having a first diameter cut and a second diameter cut larger than the first diameter cut. The engagement element includes a retaining element engaging a portion of the flap and an anchoring element engaging an external surface of the vessel, wherein the retaining element and the anchoring element exert a compressive force on the vessel wall for assisting closure of the cut.
