Use of vascular closure device is safe and effective in electrophysiological procedures

A comparison of figure-of-8-suture versus manual compression for venous access closure after cardiac procedures: An updated meta-analysis

BACKGROUND

Manual compression (MC) is the current standard to achieve postprocedural hemostasis in patients who need venous vascular access closure after cardiovascular procedures. Figure-of-8 (F8) suture for venous access closure has been reported to be a safe and efficacious alternative to MC.

METHODS

A systematic search was done using PubMed, Google Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without language restriction up until April 15, 2020 for studies comparing F8 suture versus MC. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated using a random effects model.

RESULTS

Time to achieve hemostasis was significantly reduced in the F8 arm [MD -21.04 min (95% CI: -35.66 to -6.42; P = .005)]. Access site bleeding was significantly lower in the F8 group [RR 0.35 (95% CI: 0.18 to 0.66; P = .001)] along with a lower incidence of hematoma formation [RR 0.42 (95% CI: 0.26 to 0.67; P = .0003)]. There was no significant difference in rates of fistula or pseudoaneurysm formation between the two groups. Overall access site complications were lower in the F8 arm [RR 0.38 (95% CI: 0.26 to 0.55; P < .00001)] and the effect was more pronounced for sheaths ≥10 Fr [RR 0.33 (95% CI: 0.18 to 0.60; P = .0003)]. There was lower postprocedural protamine use in the F8 group [RR 0.07 (95% CI: 0.01 to 0.36; P = .001)].

CONCLUSION

For large-bore venous access closure, the F8 suture results in a shortened time to achieve hemostasis along with a lower overall risk of access site complications and postprocedural protamine use.

Efficacy and Safety of Subcutaneous Fellow's Stitch Using "Fisherman's Knot" Technique to Achieve Large Caliber (> 10 French) Venous Hemostasis

Background

Among patients undergoing intervention involving venous access, various techniques have been implemented to achieve hemostasis in order to reduce local access site complications, to decrease length of stay and to facilitate early ambulation. We aimed to assess the efficacy and safety of fellow’s stitch using “fisherman’s knot” (figure of Z (FoZ)) technique when compared with conventional manual compression for immediate closure of large venous sheath (> 10 French (Fr)).

Methods

Between November 2012 and March 2019, 949 patients underwent various interventions which involved venous access requiring hemostasis. All the patients were anticoagulated with heparin during the procedure. In a sequential allocation, fellow’s stitch using “fisherman’s knot” (group I: n = 384) and conventional manual compression (group II: n = 365) were used in achieving hemostasis at right/left femoral venous access site following sheath removal (> 12 Fr). A 0-Vicryl suture was used to make one deep stitch just distal to entry of sheath and one superficial stitch just proximal to entry site, thereby creating an FoZ. A fisherman’s knot was then tied, and knot was pushed down while sheath was removed. In cases where immediate hemostasis was not achieved, it was compressed for 2 min to achieve it.

Results

The mean age of 949 patients was 13.1 ± 8.2 years where male (n = 574; 65%) outnumbered female (n = 375; 35%). In group I, hemostasis was achieved immediately after tying the knot in 343 (89.3%) patients, while within ≤ 2 min of light pressure in 41 (10.7%) patients. Five (1.3%) patients had failure of stitch as suture snapped during knotting, and hemostasis was achieved by manual compression as per protocol in group I. The median time to hemostasis (1.1 vs. 14.3 min, P < 0.001), ambulation (3.3 vs. 18.9 h, P < 0.01) and hospital stay (24.6 vs. 36.8 h, P < 0.001) was significantly shorter in group I compared to group II. The minor vascular access site complications in form of hematoma (n = 6 (1.6%) vs. n = 1 (0.2%); P < 0.001), and thrombosis at femoral vein (n = 4 (1.1%) vs. n = 0 (0%); P < 0.001) were significantly higher in group II when compared to group I. The differences regarding re-bleeding and formation of arterio-venous fistula between both the groups were statistically insignificant.

Conclusion

The fellow’s stitch using “fisherman’s knot” or “FoZ” suture is a simple, efficacious and safe technique to achieve an immediate hemostasis after removal of larger venous sheath (> 10 Fr).

Figure-of-eight suture for venous hemostasis in fully anticoagulated patients after atrial fibrillation catheter ablation

Introduction

Limited data exists for types of venous closure and its associated complications in patients after atrial fibrillation (AF) catheter ablation. We evaluated the subcutaneous figure-of-eight closure (FO8) for achieving venous hemostasis after AF catheter ablation compared to manual pressure.

Methods

284 consecutive patients that underwent AF catheter ablation by two operators were included. All patients received continuous therapeutic warfarin or interrupted novel oral anticoagulants (NOAC) and heparin (ACT300-400 s) without reversal. Patients were divided into two groups: 1) sheaths were left in place and pulled once ACT < 180 s, with hemostasis being achieved with manual pressure (MP); and 2) a subcutaneous FO8 suture closed the venous access site immediately after the ablation on each groin site and sheaths were removed immediately after the ablation despite full anticoagulation with heparin and warfarin or interrupted NOAC. Sutures were removed after four hours, and the patients laid flat for an additional two hours.

Results

The MP group (n = 105) was similar to the FO8 group (n = 179). Time in bed was 573 ± 80 min for MP group vs. 373 ± 49 min for FO8 group (p < 0.0001). Eleven hematomas were seen in the MP group compared to seven in the FO8 group (P = 0.041).

Conclusions

In fully anticoagulated patients undergoing AF catheter ablation, excellent hemostasis was achieved with figure-of-eight sutures, with no major vascular complications, a lower hematoma rate, and a significantly shorter flat-time-in-bed compared to manual pressure.