A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal

Abstract

Objectives: To compare subcutaneous "Z"-stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency. Background: Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. "Z"-stitch has been introduced for this purpose in some centers but systematic data on its performance is limited. Methods: This single center study randomized consecutive patients with femoral venous access sites requiring 10F sheaths to the "Z"-stitch or manual compression for hemostasis in a 2:1 fashion. There were three co-primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler-Duplex was performed with the stitch in place and after its removal. Results: 86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 6 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10-22 F). Patients randomized to "Z"-stitch achieved hemostasis quicker [<1 min vs. 12.0 (IQR 10.0-15.0) min, P < 0.001] and ambulated sooner [7.0 (IQR 4.0-12.0) vs. 16.0 3) hr post procedure, P < 0.001] when compared with manual compression alone. The "Z"-stitch reduced rates of access site complications (OR 5 0.27, 95%CI 0.09-0.76, P 5 0.01). All imaged veins were patent before and after stitch removal. Conclusions: The "Z"-stitch is a safe and effective method of achieving hemostasis after large bore femoral venous sheath removal and results in faster hemostasis, early patient ambulation and less access site complications, without compromising vein patency when compared with manual compression alone. V C 2017 Wiley Periodicals, Inc.

Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device

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Use of 65 cm large caliber Dryseal sheaths to facilitate delivery of the Edwards SAPIEN valve to dysfunctional right ventricular outflow tracts

“…Finally, despite the large diameter, we did not experience any acute femoral venous complications. In all cases venous hemostasis was achieved with a suture, either preplaced or deployed just prior to removal of the sheath which has been shown to result in faster hemostasis and less access site complications . The use of large bore femoral sheaths has been previously reported and the necessity of this approach is likely to increase with the development of transcatheter mitral valve systems .…”

Torque device suture technique to achieve hemostasis in large‐bore venous access

“…Standard figure‐of‐eight suture is a well‐tolerated, safe, and resource efficient alternative to manual compression for hemostasis of femoral venous access sites with the added benefit of reduced procedure time, decreased time to hemostasis, reduced bleeding rate, and allowed for earlier patient ambulation . However, standard figure‐of‐eight suture technique has some limitations: First, insufficient tension with the suture knot can result in failure of hemostasis.…”

“…Typically, manual compression has been used after sheath removal to achieve post‐procedure venous hemostasis; however, full anticoagulation may prohibit immediate sheath removal or require reversal of anticoagulation. Recently, the figure‐of‐eight suture technique has become a more widely used alternative as it has been shown to be as safe and effective as manual compression . An innovative twist on this technique is the use of a stopcock device to apply tension on venous access site suture in lieu of the figure‐of‐eight suture knot for hemostasis after radiofrequency catheter ablation of atrial fibrillation .…”