title: Early ambulation after percutaneous femoral access with use of closure devices and hemostatic agents.
abstract: BACKGROUND
  Patient satisfaction after percutaneous endovascular procedures is significantly influenced by the amount of time to ambulation postprocedure. The purpose of this study was to assess the complication rates of early ambulation after use of closure devices or topical hemostatic agents for femoral access sites for endovascular procedures.
  
  
  METHODS
  A retrospective review was performed of all patients who underwent an endovascular procedure from a femoral access site between January 2004 and March 2008. The access site was closed with an Angio-Seal, StarClose, or D-Stat Dry with pressure. Patients ambulated 2 hr postprocedure when a closure device was used and 4 hr postprocedure when a D-Stat pad was applied. Access-site bleeding complications were assessed. Sheath size, closure method, patient characteristics, and antiplatelet status were analyzed.
  
  
  RESULTS
  A total of 245 patients with a mean age of 70 years were identified. Of these, 154 (63%) patients were treated with a D-Stat pad with pressure, Angio-Seal was used on 83 (34%), and StarClose was used on eight (3%). The overall complication rate was 5.7%. Complications increased with increasing age (p = 0.003) and use of StarClose (p = 0.0001). The D-Stat pad was associated with a decreased complication rate (p = 0.03). Sheath size did not influence the incidence of bleeding. There was no significant increase in complications in patients taking an antiplatelet agent.
  
  
  CONCLUSIONS
  With a protocol using closure devices and hemostatic agents, early ambulation after percutaneous femoral access can be achieved safely with an acceptable complication rate in patients with peripheral vascular disease.
authors.affiliation: Veterans Administration San Diego Healthcare System, Section of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, San Diego, CA 92103, USA.
authors.forename: Travis L
authors.initials: TL
authors.lastname: Engelbert
authors.forename: Anjali
authors.initials: A
authors.lastname: Scholten
authors.forename: Kari
authors.initials: K
authors.lastname: Thompson
authors.forename: Adam
authors.initials: A
authors.lastname: Spivack
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kansal
mesh_terms: D000287:Administration, Topical; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D004434:Early Ambulation / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011677:Punctures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics