Preclosure of large-sized venous access sites in adults undergoing transcatheter structural interventions

Catheter Cardiovasc Interv. 2013 Mar;81(4):586-90. doi: 10.1002/ccd.24358. Epub 2012 Nov 8.

Abstract

Background: Patients requiring congenital and structural heart interventions often require large-sized sheath insertion into femoral veins and arteries. Clinical outcome data on the use of suture-mediated devices for femoral venous access site closure are limited.

Objective: To assess the efficacy and safety of the Perclose™ (Abbott Vascular Devices, CA) suture-mediated device using the preclosure technique, in achieving haemostasis at femoral venous access site following large sheath insertion (≥8 Fr).

Design and setting: Two hundred and forty-three consecutive patients underwent 310 access site closures with the Perclose™ device using the preclosure technique. There were 151 (62%) women, mean age 43 (±16) years. 234/243 (96%) received heparin. Mean venous access site sheath diameter was 11.5 (±3) Fr.

Results: Immediate haemostasis (<2 min) was achieved in 304/310 (98%) sites. No patients had major complications. Short-term follow-up at 3 months revealed no evidence of haematoma or fistula formation or clinical evidence of vessel occlusion. On medium-term clinical follow-up (mean follow-up of 14 ± 12 and median of 12.4 months), no complications were seen at the venous access sites.

Conclusion: Preclosure of large-size femoral venous access sheath sites using the suture-mediated Perclose™ device is efficacious in achieving rapid haemostasis in the presence of anticoagulation in the venous site. On 1-year follow-up, there was no clinical evidence of vascular complications in the venous access sites.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / methods*
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / instrumentation
  • Catheterization, Peripheral / methods*
  • Equipment Design
  • Female
  • Femoral Vein*
  • Heart Defects, Congenital / therapy*
  • Hemorrhage / etiology
  • Hemorrhage / prevention & control*
  • Hemostatic Techniques* / adverse effects
  • Hemostatic Techniques* / instrumentation
  • Heparin / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Punctures
  • Retrospective Studies
  • Suture Techniques* / adverse effects
  • Suture Techniques* / instrumentation
  • Time Factors
  • Treatment Outcome
  • Vascular Access Devices
  • Young Adult

Substances

  • Anticoagulants
  • Heparin