New approaches to achieving hemostasis after venous access in cardiovascular patients

Abstract

Recent decades have seen a series of advances in percutaneous transvenous procedures for cardiac arrhythmias, including the implantation of leadless pacemakers. Many of these procedures require the insertion of large caliber sheaths in large veins, usually the femoral vein. Securing hemostasis efficiently and reliably at the access site is a key step to improving a procedure's safety profile. Traditionally, hemostasis was achieved by manual compression of venous access sites, but the trend toward larger sheaths and the increased use of uninterrupted anticoagulation has pushed the limits of this method. Achieving hemostasis by compression alone in these circumstances requires more attention and longer duration, leading to greater patient discomfort and prolonged immobility. In turn, manual compression may be more time-consuming for medical professionals and increase the number of occupied hospital beds. New approaches have been developed to facilitate early ambulation, decrease patient discomfort, and address the risk of access site complications. These approaches include vascular closure devices and subcutaneous suture techniques including figureof-eight and purse-string sutures. This article reviews the new approaches applied to achieve venous access site hemostasis in patients undergoing transvenous procedures for cardiac arrhythmias.

Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation

“…[1][2][3] Key factors in reducing these complications include ultrasound-guided access, adequate periprocedural anticoagulation management, and femoral venous hemostasis. 4,5 Until recently, the latter has traditionally been achieved using manual compression. Over the last decade, the use of subcutaneous suture techniques and vascular closure devices (VCDs) has gained traction in the postablation setting.…”

“…Over the last decade, the use of subcutaneous suture techniques and vascular closure devices (VCDs) has gained traction in the postablation setting. 5 VCDs can broadly be divided into two categories: active VCDs that mechanically seal the opening of the vessel (e.g., Perclose ProGlide; Abbott) and passive VCDs that tamponade the vascular access site on the adventitial side to achieve hemostasis (e.g., VASCADE, Cardiva; Mynx, AccessClosure) 5 (Figure 1). Compared with manual compression, VCDs have been shown to reduce time to hemostasis and bed rest duration.…”

“…Femoral access site complications remain the most common adverse event following catheter ablation of atrial fibrillation (AF) 1–3 . Key factors in reducing these complications include ultrasound‐guided access, adequate periprocedural anticoagulation management, and femoral venous hemostasis 4,5 . Until recently, the latter has traditionally been achieved using manual compression.…”

“…Until recently, the latter has traditionally been achieved using manual compression. Over the last decade, the use of subcutaneous suture techniques and vascular closure devices (VCDs) has gained traction in the postablation setting 5 …”