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Pre-closure of Large-Sized Arterial Access Sites in Adults Undergoing Transcatheter Structural Interventions.

Hamid T, Choudhury TR, Clarke B, Mahadevan VS - Cardiol Ther (2014)

Bottom Line: Clinical outcome data on the use of suture-mediated devices for large femoral arterial access in structural heart interventions is limited.On clinical follow up [mean (SD) follow-up of 24 (±12) months and median follow-up of 8.5 months], no complications were seen in the arterial access sites.On 1-year follow-up, there were no arterial access site complications requiring further investigations or interventions.

View Article: PubMed Central - PubMed

Affiliation: Central Manchester University Hospitals, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.

ABSTRACT

Introduction: Patients undergoing structural heart interventions often require large-sized sheath insertion into femoral arteries and veins. Clinical outcome data on the use of suture-mediated devices for large femoral arterial access in structural heart interventions is limited. We assessed the efficacy of the Perclose™ (Abbott Vascular Devices, Santa Clara, CA, USA) suture-mediated device using the pre-closure technique in achieving hemostasis in femoral arterial access sites following large sheath insertion (≥8 Fr).

Methods: One hundred consecutive patients underwent 101 femoral artery access sites closures with the Perclose device using the pre-closure technique. Sixty-two percent of the patients were male and their mean (SD) age was 52 (±26) years. All patients received heparin.

Results: Mean arterial access site sheath diameter was 13 ± 2 Fr. Immediate hemostasis was achieved in 96/101 (96%) procedures (≤2 min). Two patients (2%) had access site-related complications requiring further interventions. On clinical follow up [mean (SD) follow-up of 24 (±12) months and median follow-up of 8.5 months], no complications were seen in the arterial access sites.

Conclusion: Pre-closure of large-size femoral arterial access sheath sites using the suture-mediated Perclose device is efficacious in achieving rapid hemostasis in patients undergoing structural interventions. On 1-year follow-up, there were no arterial access site complications requiring further investigations or interventions.

No MeSH data available.


Rewiring of the vessel following pre-deployment of the Perclose™ (Abbott Vascular Devices, Santa Clara, CA, USA) device
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Fig2: Rewiring of the vessel following pre-deployment of the Perclose™ (Abbott Vascular Devices, Santa Clara, CA, USA) device

Mentions: Femoral arterial access was obtained by Seldinger technique [7]. After wire insertion, a 6 Fr dilator was used for dilatation. Subsequently, a 6 Fr Perclose (A-T or Proglide; Abbott Vascular Devices) device was inserted and the wire was removed. Spontaneous blood flow through the side port was observed. The footplate of the device was deployed and the device pulled back and sutures set as usual. The footplates were released and the device partially retrieved until the port for the guide wire was visible (Figs. 1, 2). The guide wire was reintroduced into the artery and the device removed. An appropriately sized sheath was inserted. Upsizing of sheaths as required was performed using normal techniques. The sutures were tightened at the end of the procedure upon removal of the sheath(s) from the vessel.Fig. 1


Pre-closure of Large-Sized Arterial Access Sites in Adults Undergoing Transcatheter Structural Interventions.

Hamid T, Choudhury TR, Clarke B, Mahadevan VS - Cardiol Ther (2014)

Rewiring of the vessel following pre-deployment of the Perclose™ (Abbott Vascular Devices, Santa Clara, CA, USA) device
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472648&req=5

Fig2: Rewiring of the vessel following pre-deployment of the Perclose™ (Abbott Vascular Devices, Santa Clara, CA, USA) device
Mentions: Femoral arterial access was obtained by Seldinger technique [7]. After wire insertion, a 6 Fr dilator was used for dilatation. Subsequently, a 6 Fr Perclose (A-T or Proglide; Abbott Vascular Devices) device was inserted and the wire was removed. Spontaneous blood flow through the side port was observed. The footplate of the device was deployed and the device pulled back and sutures set as usual. The footplates were released and the device partially retrieved until the port for the guide wire was visible (Figs. 1, 2). The guide wire was reintroduced into the artery and the device removed. An appropriately sized sheath was inserted. Upsizing of sheaths as required was performed using normal techniques. The sutures were tightened at the end of the procedure upon removal of the sheath(s) from the vessel.Fig. 1

Bottom Line: Clinical outcome data on the use of suture-mediated devices for large femoral arterial access in structural heart interventions is limited.On clinical follow up [mean (SD) follow-up of 24 (±12) months and median follow-up of 8.5 months], no complications were seen in the arterial access sites.On 1-year follow-up, there were no arterial access site complications requiring further investigations or interventions.

View Article: PubMed Central - PubMed

Affiliation: Central Manchester University Hospitals, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.

ABSTRACT

Introduction: Patients undergoing structural heart interventions often require large-sized sheath insertion into femoral arteries and veins. Clinical outcome data on the use of suture-mediated devices for large femoral arterial access in structural heart interventions is limited. We assessed the efficacy of the Perclose™ (Abbott Vascular Devices, Santa Clara, CA, USA) suture-mediated device using the pre-closure technique in achieving hemostasis in femoral arterial access sites following large sheath insertion (≥8 Fr).

Methods: One hundred consecutive patients underwent 101 femoral artery access sites closures with the Perclose device using the pre-closure technique. Sixty-two percent of the patients were male and their mean (SD) age was 52 (±26) years. All patients received heparin.

Results: Mean arterial access site sheath diameter was 13 ± 2 Fr. Immediate hemostasis was achieved in 96/101 (96%) procedures (≤2 min). Two patients (2%) had access site-related complications requiring further interventions. On clinical follow up [mean (SD) follow-up of 24 (±12) months and median follow-up of 8.5 months], no complications were seen in the arterial access sites.

Conclusion: Pre-closure of large-size femoral arterial access sheath sites using the suture-mediated Perclose device is efficacious in achieving rapid hemostasis in patients undergoing structural interventions. On 1-year follow-up, there were no arterial access site complications requiring further investigations or interventions.

No MeSH data available.