title: Preclosure of large-sized venous access sites in adults undergoing transcatheter structural interventions.
abstract: BACKGROUND
  Patients requiring congenital and structural heart interventions often require large-sized sheath insertion into femoral veins and arteries. Clinical outcome data on the use of suture-mediated devices for femoral venous access site closure are limited.
  
  
  OBJECTIVE
  To assess the efficacy and safety of the Perclose™ (Abbott Vascular Devices, CA) suture-mediated device using the preclosure technique, in achieving haemostasis at femoral venous access site following large sheath insertion (≥8 Fr).
  
  
  METHODS
  Two hundred and forty-three consecutive patients underwent 310 access site closures with the Perclose™ device using the preclosure technique. There were 151 (62%) women, mean age 43 (±16) years. 234/243 (96%) received heparin. Mean venous access site sheath diameter was 11.5 (±3) Fr.
  
  
  RESULTS
  Immediate haemostasis (<2 min) was achieved in 304/310 (98%) sites. No patients had major complications. Short-term follow-up at 3 months revealed no evidence of haematoma or fistula formation or clinical evidence of vessel occlusion. On medium-term clinical follow-up (mean follow-up of 14 ± 12 and median of 12.4 months), no complications were seen at the venous access sites.
  
  
  CONCLUSIONS
  Preclosure of large-size femoral venous access sheath sites using the suture-mediated Perclose™ device is efficacious in achieving rapid haemostasis in the presence of anticoagulation in the venous site. On 1-year follow-up, there was no clinical evidence of vascular complications in the venous access sites.
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester and Manchester University Children's Hospital, United Kingdom.
authors.forename: Tahir
authors.initials: T
authors.lastname: Hamid
authors.forename: Rajinikanth
authors.initials: R
authors.lastname: Rajagopal
authors.forename: Charlene
authors.initials: C
authors.lastname: Pius
authors.forename: Bernard
authors.initials: B
authors.lastname: Clarke
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005268:Femoral Vein; D006330:Heart Defects, Congenital / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin