title: Percutaneous arterial closure in peripheral vascular disease: a prospective randomized evaluation of the Perclose device.
abstract: BACKGROUND
  Patients with peripheral vascular disease have been excluded from initial studies of percutaneous suture-mediated closure devices (SMCD) despite representing a significant proportion of those requiring endovascular intervention. We sought to determine whether these devices could be safely used in patients with peripheral vascular disease.
  
  
  METHODS
  Patients were stratified into two groups and five subgroups on the basis of indication for arteriography, and they were prospectively randomized at the end of the procedure to receive either the SMCD or manual compression. Ankle-brachial index was determined and duplex ultrasound scanning of the accessed femoral artery was performed, before and after the procedure. Ultrasound data included peak systolic velocity, minimum intraluminal vessel diameter, and presence or absence of calcified plaque. Time to hemostasis, ambulation, and discharge were recorded, and major or minor complications were noted.
  
  
  RESULTS
  Of 102 patients included in the study, 52 patients were randomized to receive the SMCD. There was no difference in ankle-brachial index, minimum intraluminal vessel diameter, or peak systolic velocity in the accessed vessel after closure with SMCD or manual compression. Time to hemostasis, ambulation, and discharge was significantly less in the SMCD group (P =.001). Presence of calcified plaque was not associated with complications (P =.146). In the SMCD group, hemostasis was achieved with 49 of 52 devices (94.2%). There were six complications (5.9%), two of which were major and required operative intervention. All complications were hemorrhagic and not occlusive. There was no difference in overall complication rate between SMCD (7.7%) and manual compression (4.0%) groups (P =.678). No infection was noted in any of the 102 patients.
  
  
  CONCLUSIONS
  Suture-mediated percutaneous arterial closure can be safely performed in patients with peripheral vascular disease, even in the presence of calcified plaque. This closure technique enables shorter time to hemostasis, ambulation, and hospital discharge. There are observed differences in minor, but not major, complication rates for MC versus percutaneous arterial closure in patients with peripheral vascular disease, but these differences did not achieve statistical significance in this small series.
authors.affiliation: Peripheral Vascular Surgery Clinic W64, Walter Reed Army Medical Center, 6400 Georgia Avenue NW, Washington, DC 20854, USA. Benjamin.Starnes@NW.AMEDD.ARMY.MIL
authors.forename: B W
authors.initials: BW
authors.lastname: Starnes
authors.forename: S D
authors.initials: SD
authors.lastname: O'Donnell
authors.forename: D L
authors.initials: DL
authors.lastname: Gillespie
authors.forename: J M
authors.initials: JM
authors.lastname: Goff
authors.forename: P
authors.initials: P
authors.lastname: Rosa
authors.forename: M V
authors.initials: MV
authors.lastname: Parker
authors.forename: A
authors.initials: A
authors.lastname: Chang
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000150:complications*; D002406:Catheterization, Peripheral / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications*; D011446:Prospective Studies; D011677:Punctures; D013536:Suture Techniques / Q000295:instrumentation*