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Adjunct Techniques to Increase Success Rate of Suture Mediated Vascular Closure Devices in Percutaneous Endovascular Procedures: a Technical ReviewArticle

Dennis H Lui, Alexander Cole, Shadeh Parsapour, Syed T Hussain, Martin Malina, Nada Selva Theivacumar*

Objectives: Percutaneous access is now the norm for many endovascular procedures. Suture-mediated closure devices are commonly used for vessel repair after percutaneous access. Incomplete hemostasis after device deployment is not uncommon. Several adjuncts to suture mediated closure have been described, which allow operators to optimise hemostasis, and potentially avoid surgical exposure and repair of the punctured vessel. We review and compare different adjunct techniques to augment hemostasis after suture-mediated vascular closure device deployment.

Methods: We performed a literature search of MEDLINE using a combined search strategy of Mesh terms. Articles documenting adjunct techniques and maneuvers used after suture-mediated closure of 11-25 French arteriotomies in the femoral artery were included and reviewed.

Results: Currently used adjunct techniques may be divided into two categories, compression adjuncts and plugging adjuncts. Compression adjuncts include external pneumatic compression devices, tractional compression techniques and puncture point compression techniques. Plugging adjuncts involve the directed application of hemostatic agents or reinforcing materials against the femoral artery and puncture tract. These adjuncts have demonstrated effectiveness in augmenting hemostasis, albeit in small and heterogeneous studies and series.

Conclusion: Adjunct techniques can be useful for remedying incomplete hemostasis where suture-mediated closure has been partially successful. Although not a replacement for definitive surgical repair for incomplete hemostasis, they can improve the rate of successful vessel repair in percutaneous endovascular procedures. More than one adjunct may be combined to achieve adequate hemostasis in difficult cases.