title: Immediate ambulation following diagnostic coronary angiography procedures utilizing a vascular closure device (The Closer).
abstract: OBJECTIVE
  We investigated the safety and efficacy of The Closer, a suture-mediated vascular closure device, to facilitate immediate ambulation after diagnostic coronary angiography.
  
  
  RESULTS
  We identified 487 non-consecutive patients who were eligible for an immediate ambulation protocol following vascular closure after diagnostic coronary angiography. A total of 434 patients (89%) were allowed immediate ambulation (mean time, 6.3 +/- 2.4 minutes) and 34 patients (7%) were treated with intermediate duration bed rest (mean time, 105.2 +/- 55.3 minutes). Of the 34 patients treated with intermediate duration bed rest, ten had minor bleeding from the arterial access tract requiring 2 5 minutes of light compression and 24 were delayed secondary to physician preference. Nineteen patients (4%) failed to achieve hemostasis with The Closer. Outpatients were followed up at 24 hours, and inpatients were followed up the next morning. Four patients (0.8%) suffered recurrent femoral artery bleeds after initially successful vascular closure. Three recurrent bleeds occurred during the observation period in-hospital and one occurred 6 days after device deployment. At follow-up, no patients developed the following: hematoma > 4 cm, ipsilateral retroperitoneal bleed, arterio-venous fistula, pseudoaneurysm, access site infection or loss of distal pulses. No patients had lower extremity ischemia or required blood transfusion.
  
  
  CONCLUSIONS
  Use of The Closer after diagnostic angiography with subsequent immediate ambulation is safe and effective for most patients. Overall, hemostasis was achieved in 96% of patients, with 89% of our patients able to ambulate immediately and 7% able to ambulate after intermediate duration bed rest.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crocker
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Cragun
authors.forename: Farris K
authors.initials: FK
authors.lastname: Timimi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Houlihan
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Bell
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis*; D004434:Early Ambulation; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors