title: Angiographic changes following the use of a purse-string suture hemostasis device in hemodialysis access interventions.
abstract: OBJECTIVE
  To evaluate late angiographic changes at the puncture site with use of a suture lock device for hemostasis after hemodialysis access interventions.
  
  
  METHODS
  Thirty-five patients who underwent percutaneous intervention of a failing or thrombosed access had 76 puncture sites (58 grafts, 15 fistulas, three composite) managed with a purse-string suture lock device. All patients had follow-up fistulograms available for analysis. Fistulograms at the site of sheath insertion were retrospectively compared with those obtained during subsequent hemodialysis access procedures to assess for changes in access lumen diameter. Access type, sheath size, and heparin dose were examined as predictors of access diameter change at the puncture site.
  
  
  RESULTS
  The mean time to follow-up fistulography was 4.7 months; the cumulative observation time of the patient cohort was 30.5 dialysis years. The mean change in access diameter at the previous puncture site was -0.3%. No puncture sites became aneurysmal or stenotic during follow-up. Two of the 76 puncture sites (both grafts) developed mild (+28%) and moderate (+43%) bulging at the sheath site. The remaining 74 puncture sites (97%) showed no significant change in access diameter. The mean change in access diameter among fistulas was -6.2%, and that among grafts was +1.5% (P = .06). Neither sheath size (P = .26) nor heparin dose (P = .48) had an effect on access diameter.
  
  
  CONCLUSIONS
  No patients developed aneurysms or stenosis at the puncture site after use of a suture lock device for hemostasis. This technique is consistent, safe, and effective in obtaining hemostasis after dialysis access interventions of fistulas and grafts.
authors.affiliation: Section of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016, USA. timothy.clark@nyumc.org
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.forename: Shawn
authors.initials: S
authors.lastname: Haji-Momenian
authors.forename: Andrew
authors.initials: A
authors.lastname: Kwak
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.forename: Aalpen
authors.initials: A
authors.lastname: Patel
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D015901:Angiography, Digital Subtraction; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004867:Equipment Design; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006438:Hemodilution; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D011677:Punctures; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors