Use of suture‐mediated vascular closure devices for the management of femoral vein access after transcatheter procedures

Abstract

Groin complications remain the most common complication of cardiac catheterization procedures. While the use of closure devices is increasing for arterial sheaths, venous sheaths tend to be removed and hemostasis achieved with manual compression. We report our experience using Perclose suture-mediated vascular closure device to achieve hemostasis and early mobility in patients who have had venous access as part of their procedure. There were a total of 42 patients (21 males; average age, 63.5 years) studied. The majority of the patients had 7 Fr sheaths (24), with access sites of sheaths up to 14 Fr being closed with this technique. Two patients developed complications at the access site: one patient requiring rehospitalization for intravenous antibiotics because of late access site infection, and one patient with deep venous thrombosis and pulmonary emboli. We conclude that the use of the Perclose suture-mediated closure device for closure of femoral venous access sites is feasible and should be considered especially in patients with larger venous sheaths and those at increased risk of groin complications.

Pre-closure of femoral venous access sites used for large-sized sheath insertion with the Perclose device in adults undergoing cardiac intervention

“…There are two previously reported series on the use of closure devices in venous sites,3 4 one of which used an earlier version of the Perclose device4 in which the majority had 7Fr sheaths. In contrast to previous studies3 4 the devices were predeployed in this study.…”

Access site management with vascular closure devices for percutaneous transarterial procedures

“…Similar to other devices, this device can achieve a high degree of success even in patients who receive anticoagulation. 22,48,[58][59][60][61][62] An unusual complication of femoral arteritis has been reported with early platform of Perclose device which used a braided suture. 48,69,70 The introduction of the ProGlide model, which incorporated an improved suture trimming mechanism and replaced braided suture with monofilament polypropylene suture, has reduced the incidence of device failure and lowered the risk of infectious complication.…”

“…While several clinical studies reported device success rates ranging from 90% to 100% which is similar to other devices. 22,48,[58][59][60][61][62] Device failure, while uncommon, has been attributed to suture breakage or failure to create a secured knot. If the Perclose device fails, MC can achieve hemostasis.…”

“…63 Comparative studies between the Perclose device vs manual compression noted a faster time to achieve hemostasis and ambulation when using the Perclose device. 22,48,[58][59][60][61][62] There are multiple small randomized studies comparing Perclose to MC in the setting of diagnostic angiography, PCI, and both. The results are mixed; some favor Perclose with fewer complications 41,52,64,65 and others favor MC.…”

Venous hemostasis postcatheter ablation of atrial fibrillation while under therapeutic levels of oral and intravenous anticoagulation

“…The use of the Perclose (Abbott Vascular Devices, Redwood City, CA) suture-mediated device for femoral vein access site closure following large (>8 Fr) sheath insertion was associated with a 98 % success rate of immediate (within 2 min) hemostasis in a wide range of congenital and structural cardiac interventions [16][17][18][19]. In one report, the Angio-Seal (St. Jude Medical, Minnetonka, MN) collagen-mediated, anchor-based vascular sealing device was found safe and successful for femoral venous hemostasis (in patients with venous sheaths ≤8 Fr), with no major complications, even in the presence of anticoagulation and antiplatelet agents [20].…”