Subcutaneous double purse-string suture closure after large-caliber venous sheath removal for leadless pacemaker implantation was safe, with access site complications occurring in 3.9% of patients.
Observational (n=77)
No
Does subcutaneous double purse-string suture provide safe femoral vein access site closure in patients undergoing leadless pacemaker implantation?
Subcutaneous double purse-string suture is a safe and effective method for achieving hemostasis after the removal of large-caliber venous sheaths during leadless pacemaker implantation.
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. Conclusion 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.
Kypta et al. (Sun,) conducted a observational in Leadless cardiac pacemaker implantation (n=77). Subcutaneous double purse-string suture (PSS) was evaluated on Access site complications. Subcutaneous double purse-string suture closure after large-caliber venous sheath removal for leadless pacemaker implantation was safe, with access site complications occurring in 3.9% of patients.