title: Suture-mediated percutaneous closure of antegrade femoral arterial access sites in patients who have received full anticoagulation therapy.
abstract: OBJECTIVE
  To assess the feasibility and clinical usefulness of suture-mediated closure of femoral arterial access sites after antegrade puncture for peripheral arterial interventions.
  
  
  METHODS
  Eighty consecutive patients (49 men, 31 women; mean age +/- SD, 65.4 years +/- 12.3) who had undergone femoropopliteal angioplasty underwent suture-mediated percutaneous closure with 6-, 7-, or 8-F devices. Patients received heparin intravenously and aspirin orally and were immobilized for 1 hour after the intervention. All patients underwent a physical examination the day after the procedure. Color-coded duplex ultrasonography was performed in those patients (n = 27 [33%]) who were obese, were experiencing pain, and had suspicious clinical findings. After 3 months, an identical clinical examination was performed in every third patient.
  
  
  RESULTS
  Hemostasis was achieved in 77 (96%) patients; one of 80 patients required blood transfusions and surgery despite an initially successful closure. The closure devices could be deployed in 78 (98%) patients; two of 80 patients needed compression because of a steep angulation of the puncture track and suture entrapment. Adjunctive compression was necessary in two (3%) of the remaining 78 patients. Mean time to hemostasis in the 78 patients who had successful device deployment was 5.2 minutes (range, 3.0-21.0 minutes). Minor complications (i.e., three small hematomas, a pseudoaneurysm, and a small lymphatic fistula) occurred in five (6%) patients.
  
  
  CONCLUSIONS
  Suture-mediated percutaneous closure of antegrade puncture sites in the groin is feasible. Problems may arise in antegrade punctures owing to steep device angulation.
authors.affiliation: Department of Radiology, Eberhard-Karlsx Universität Tübingen, Germany.
authors.forename: S H
authors.initials: SH
authors.lastname: Duda
authors.forename: J
authors.initials: J
authors.lastname: Wiskirchen
authors.forename: M
authors.initials: M
authors.lastname: Erb
authors.forename: U
authors.initials: U
authors.lastname: Schott
authors.forename: K
authors.initials: K
authors.lastname: Khaligi
authors.forename: P L
authors.initials: PL
authors.lastname: Pereira
authors.forename: J
authors.initials: J
authors.lastname: Albes
authors.forename: C D
authors.initials: CD
authors.lastname: Claussen
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D005260:Female; D005263:Femoral Artery; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures; D013536:Suture Techniques / Q000295:instrumentation*; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D000925:Anticoagulants; D006493:Heparin; D001241:Aspirin