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Pre-closure of femoral venous access sites used for large sized Sheath Insertion with the Perclose™ device in adults undergoing cardiac intervention
  1. Vaikom S Mahadevan (vsmkm{at}yahoo.co.uk)
  1. Toronto General Hospital, Canada
    1. Sue S Jimeno (socorro.jimeno{at}uhn.on.ca)
    1. Toronto General Hospital, Canada
      1. Lee N Benson (lee.benson{at}sickkids.ca)
      1. Hospital for Sick Children, Toronto, Canada
        1. Peter R McLaughlin (petermclaughlin{at}rogers.com)
        1. Toronto General Hospital, Canada
          1. Eric M Horlick (eric.horlick{at}uhn.on.ca)
          1. Toronto General Hospital, Canada

            Abstract

            Objective Interventional procedures in adults with congenital cardiac conditions often require insertion of large sized sheaths in the femoral veins. Data on use of suture mediated devices for femoral venous access site closure is scant and no data is available regarding venous patency following device use. This study assessed efficacy of the 6 Fr. Perclose™(Abbott Vascular Devices, CA, USA) suture mediated device in achieving hemostasis and venous patency after closure.

            Design and Setting One hundred and forty-six consecutive patients (80 females, mean age 45±14 years) undergoing closure of 205 femoral venous access sites in a tertiary cardiac centre. All received heparin and were on concomitant aspirin and/or clopidogrel. The majority (98%) had a ≥10 Fr. sheath inserted.

            Results Immediate haemostasis was achieved in 202 (99%) of sites. Two patients (1.4%) had a major complication. On follow-up (n=111, mean 71±33 days) there was no evidence of haematoma or fistula formation. Doppler studies from a subgroup of 43 (29%) patients (mean age 45¡¾15 years, mean follow up 47±18 days), revealed a common femoral venous diameter of 11.6±2.7 mm on the device closed right and 12.2±2.5 mm on the left vein (p>0.05). All accessed veins were patent with no pseudoaneurysm or arteriovenous fistula formation.

            Conclusion Pre-closure of large sheath size femoral venous access sites using the suture mediated Perclose™ device is efficacious in achieving rapid hemostasis in the presence of anticoagulation. Doppler follow up reveals no loss of venous patency or luminal venous diameter as compared to the contralateral side.

            • Access site
            • Femoral vein
            • Groin
            • Perclose

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