Suture closure of femoral arterial puncture sites after coronary angioplasty followed by same-day discharge.
BACKGROUND
The purpose of this study was to determine whether immediate suture closure of 8F femoral arterial puncture sites can facilitate same-day discharge after coronary angioplasty.


RESULTS
After coronary angioplasty, 100 patients were randomly assigned to immediate sheath removal with the double-suture Prostar-Plus device or delayed sheath removal with application of a c-clamp. After suture closure, mobilization at 4 hours after sheath removal and discharge 4 hours later were planned. Patients treated with the c-clamp had sheaths removed 4 hours after percutaneous transluminal coronary angioplasty, were mobilized 6 hours later, and discharged the following day. Patients were assessed for groin complications at 8, 24, and 72 hours. Overall, patients who received suture closure were mobilized at 7.1 +/- 5.3 hours and discharged 11. 15 +/- 6.22 hours after sheath removal versus 15.49 +/- 3.9 hours and 21.9 +/- 3.8 hours for patients with the c-clamp (P <.001). Initial failure of the suture device occurred in 5 patients, with 1 requiring surgery for an entrapped device. After the procedure, patients with suture closure more frequently had an ooze of blood (55% vs 24%, P <.001) and a trend to more overt external bleeding (10% vs 2%, P = not significant). Hematomas were reported by 20% of patients in both groups at 72 hours. Overall, patients preferred the suture closure method of sheath removal when assessed by a simple questionnaire. An economic analysis by cost minimization demonstrated potential hospital cost saving.


CONCLUSIONS
Suture closure of 8F arterial puncture sites can facilitate early mobilization and same-day discharge and is considered acceptable by more patients compared with application of the c-clamp. There is potential to realize cost savings with a strategy of same-day discharge.
Carere
R G
RG
Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver. rgcarere@unixg.ubc.ca
Webb
J G
JG
Buller
C E
CE
Wilson
M
M
Rahman
T
T
Spinelli
J
J
Anis
A H
AH
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003327:Coronary Disease / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017060:Patient Satisfaction; D011677:Punctures; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome