title: Suture closure of the femoral arteriotomy following invasive cardiac procedures: a detailed analysis of efficacy, complications, and the impact of early ambulation in 1,200 consecutive, unselected cases.
abstract: The purpose of this study was to assess the efficacy and safety of using a percutaneous suture device to close femoral arteriotomies following invasive cardiac procedures. All patients presenting for invasive cardiac procedures performed from the femoral artery were considered for suture closure. Patients were carefully assessed for access site complications, oozing, and the impact of suture closure on the safety of early ambulation. Clinical follow-up at 3-6 months was performed to assess for late complications. Femoral artery suture closures were performed in 1,200 consecutive cases in 1,097 patients. In 12.8% of cases, the patients ambulated within 1 hr. The success rate was 91.2% and the complication rate was 3.4%. Complications included the development of a hematoma (2.1%), the need for vascular surgery (0.6%), retroperitoneal hemorrhage (0.3%), blood transfusion (0.7%), local infection (0.5%), and pseudoaneurysm formation (0.1%). Factors found to be independently predictive of procedural failure were an age > 70 years, an ACT > 300 sec, left femoral artery access, and the performance of primary angioplasty. Follow-up at 3-6 months revealed no major hemorrhagic complications. We conclude that percutaneous suture closure effectively achieves femoral artery hemostasis in patients undergoing invasive cardiac procedures. The technique permits early ambulation and is associated with a relatively low incidence of complication.
authors.affiliation: Division of Cardiology, Hartford Hospital, University of Connecticut, Hartford, Connecticut, USA. dfram@harthosp.org
authors.forename: D B
authors.initials: DB
authors.lastname: Fram
authors.forename: S
authors.initials: S
authors.lastname: Giri
authors.forename: G
authors.initials: G
authors.lastname: Jamil
authors.forename: J F
authors.initials: JF
authors.lastname: Mitchel
authors.forename: W E
authors.initials: WE
authors.lastname: Boden
authors.forename: S
authors.initials: S
authors.lastname: Din
authors.forename: F J
authors.initials: FJ
authors.lastname: Kiernan
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000209:etiology; D001803:Blood Transfusion; D015992:Body Mass Index; D004434:Early Ambulation; D023381:Endpoint Determination; D019544:Equipment Failure Analysis; D004869:Equipment Safety; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000628:therapy*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques / Q000295:instrumentation*; D017211:Treatment Failure; D016896:Treatment Outcome