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

Stephan H. Duda, MD1, Jakub Wiskirchen, MD1, Michael Erb, MD2, Ulrich Schott, MD1, Khourosh Khaligi, MD2, Philippe L. Pereira, MD1, Johannes Albes, MD2 and Claus D. Claussen, MD1

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.



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  		Figure 1. Schematic drawing of percutaneous vascular suturing device, which has a flexible sheath that encloses the suturing needles (straight arrows) and a barrel (open arrow) that receives the deployed needles. A = lumen of the common femoral artery.

 


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  		Figure 2. Photograph of pulsatile flow (arrow) exiting from the marker port, which indicates proper positioning of the device.

 


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  		Figure 3. Schematic drawing of deployment of needles (straight black arrows) and sutures (white arrows) through the arterial wall (curved black arrow) around the puncture site.

 


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  		Figure 4. Photograph of knot pusher (arrow) sliding the square knot and two overhand throw knots down to the artery. The knot pusher tightens the arterial tissue and brings the tissue layers into apposition.

 


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  		Figure 5. Schematic drawing of the closed arterial access site after the removal of the percutaneous vascular suturing device and the cutting of the sutures. The area magnified in the box in the lower left corner is indicated by the curved arrow.

 




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