Closure of Large Percutaneous Femoral Venous access using a Modified “Figure-of-Eight” Suture

Abstract

<jats:p> Recent advances in different percutaneous treatments made insertion of large-caliber sheaths in the femoral veins more common. Venous punctures are historically managed by initial manual compression with subsequent application of a compression bandage and bed rest. We describe a modified “figure-of-eight” suture technique for minimizing the risk of accidental puncture of the vein while grabbing the subcutaneous tissue. We examined the safety and feasibility of this technique combined with early mobilization in a real-world setting. We performed a retrospective analysis on 56 consecutive patients undergoing percutaneous mitral valve repair using large femoral venous access. The patient population was heterogeneous and bleeding risk characteristics were common. Bleeding Academic Research Consortium Consensus (BARC)-classifiable bleeding complications occurred in eight patients (14%), BARC of two events or more in five patients (8.9%), and BARC of three or more event in only one patient (1.8%), which is a comparable success rate to large venous access closure with suture-mediated closure devices. No BARC Type 3b or BARC Type 5 bleeding occurred. During routine clinical follow-up, no groin-related problems were reported in all patients. Closure of large femoral venous access using a modified temporary subcutaneous figure-of-eight suture in combination of a light compression bandage and bed rest for 2 to 4 hours provides a safe and low-cost alternative to closure devices for early mobilization. </jats:p>

Purse string suture for hemostasis after removal of large-caliber femoral venous delivery sheaths in pediatric transcatheter intervention of atrial septal defect: a single center experience

“…The technique is safe and feasible, with an overall success rate of 92%. There are a few reports of surgical suture hemostasis after the removal of femoral venous sheaths in children, and the overall success rate is 98.7% [4][5][6][7][8]. It has been demonstrated that 89.3% of children cease bleeding quickly after ligation, 10.7% of them managing to stop the ow within two minutes, which indicates that the technique is highly effective in achieving rapid hemostasis in this demographic and can signi cantly reduce the time spent in hospital [13].…”

“…Wyss et al investigated 56 patients who had undergone mitral valve repair via a percutaneous femoral vein approach, and revealed that the use of a revised temporary Figure-of-Eight suture with light bandages and short bed rest time (2-4 hours) was a secure and economical hemostatic option for large femoral vein damage[4]. Multiple studies have con rmed that Figure-of-Eight suture technology can also effectively achieved femoral vein hemostatic in adult patients with atrial brillation treated by radiofrequency ablation, signi cantly reduced the risk of rebleeding, shortened bed rest time, and alleviated the discomfort of patients during the use of large-calib venous delivery sheaths[5][6][7].…”