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Suture-mediated Percutaneous Closure of Antegrade Femoral Arterial Access Sites in Patients Who Have Full Anticoagulation Therapy

¹ Departments of Radiology (S.H.D., J.W., U.S., P.L.P., C.D.C.)
² Surgery (M.E., K.K., J.A.), Eberhard-KarlsxUniversität Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.

PURPOSE: To assess the feasibility and clinical usefulness of suture-mediated closure of femoral arterial access sites after antegrade puncture for peripheral arterial interventions.

MATERIALS AND METHODS: Eighty consecutive patients (49 men, 31 women; mean age ± SD, 65.4 years ± 12.3) who had undergone femoropopliteal angioplasty underwent suture-mediated percutaneous closure with 6-, 7-, or 8-F devices. Patients received heparin intravenously and aspirin orally and were immobilized for 1 hour after the intervention. All patients underwent a physical examination the day after the procedure. Color-coded duplex ultrasonography was performed in those patients (n = 27 [33%]) who were obese, were experiencing pain, and had suspicious clinical findings. After 3 months, an identical clinical examination was performed in every third patient.

RESULTS: Hemostasis was achieved in 77 (96%) patients; one of 80 patients required blood transfusions and surgery despite an initially successful closure. The closure devices could be deployed in 78 (98%) patients; two of 80 patients needed compression because of a steep angulation of the puncture track and suture entrapment. Adjunctive compression was necessary in two (3%) of the remaining 78 patients. Mean time to hemostasis in the 78 patients who had successful device deployment was 5.2 minutes (range, 3.0–21.0 minutes). Minor complications (ie, three small hematomas, a pseudoaneurysm, and a small lymphatic fistula) occurred in five (6%) patients.

CONCLUSION: Suture-mediated percutaneous closure of antegrade puncture sites in the groin is feasible. Problems may arise in antegrade punctures owing to steep device angulation.

Index terms: Aneurysm, femoral, 921.732 • Arteries, transluminal angioplasty, 921.128, 924.128 • Interventional procedures, complications, 921.128, 924.128

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