title: Subcutaneous Double "Purse String Suture"-A Safe Method for Femoral Vein Access Site Closure after Leadless Pacemaker Implantation.
abstract: BACKGROUND
  Leadless cardiac pacemaker (LCP) requires large-caliber venous sheaths for device placement. Sheath sizes for these procedures vary from 18- to 23-French (F). The most common complications are hematomas, pseudoaneurysms, and arteriovenous fistulas. Complete and secure closure of the venous access is an important step at the end of such a procedure.
  
  
  METHODS
  We performed a retrospective analysis of all patients who had undergone LCP implantation at our institution. Patients and procedural characteristics as well as groin complications at 30 days and 3 months were evaluated. After sheath removal venous access sites were closed performing a so-called "purse-string" suture (PSS).
  
  
  RESULTS
  Seventy-seven patients received an LCP at our institution. In 27 (35%) of these patients a heparin bolus was given at the beginning of the procedure. Anticoagulation therapy with phenprocoumon was present in 32 (40%) of patients. In 76 (98.7%) patients, the LCP was implanted without complications. In one (1.3%) patient a perforation occurred during implantation, which required surgical intervention. Access site complications occurred in three (3.9%) patients, two (2.6%) groin hematomas, and one (1.3%) arteriovenous fistula. The hematomas disappeared completely after 3 weeks, and the fistula was not detectable by ultrasound anymore after 4 weeks.
  
  
  CONCLUSIONS
  Use of subcutaneous absorbable double PSS closure after removal of large-caliber venous sheaths is a safe technique to achieve immediate postprocedural hemostasis. Especially for sheath sizes with an inner diameter of 23F, this technique creates a very secure and also cosmetically appealing closure.
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kypta
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Hermann
authors.initials: H
authors.lastname: Blessberger
authors.affiliation: Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Lichtenauer
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Juergen
authors.initials: J
authors.lastname: Kammler
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lambert
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Joerg
authors.initials: J
authors.lastname: Kellermair
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nahler
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kiblboeck
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwarz
authors.affiliation: Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Steinwender
mesh_terms: D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D061214:Patient Safety; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D065506:Vascular Closure Devices / Q000009:adverse effects; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*
keywords: hemostasis; leadless pacing; percutaneous closure; venous sheaths