Femoral venous hemostasis in children using the technique of "figure-of-eight" sutures

Congenit Heart Dis. 2014 Mar-Apr;9(2):122-5. doi: 10.1111/chd.12098. Epub 2013 May 20.

Abstract

Background: Structural heart interventions require the use of relatively large-diameter delivery sheaths or latex nylon net balloon catheters, which results in a relatively large-diameter venous puncture point. At present, femoral venous hemostasis is achieved by manual compression. A temporary figure-of-eight subcutaneous suture has been introduced to achieve immediate postprocedural femoral venous hemostasis after using a ≥24Fr sheath in an adult. This method is not well evaluated in children.

Method: We report our experience using this technique in children treated with 7-14Fr sheaths. From May 2009 to March 2012, 104 children (ages ranging from 3 to 10 years, mean 8.1 ± 1.6 years) with atrial septal defects (n = 86) and pulmonary valve stenosis (n = 18) underwent percutaneous transcatheter interventions. Sheath sizes used were ≥7Fr (7Fr, n = 5; 8Fr, n = 29; 9Fr, n = 14; 10Fr, n = 15; 12Fr, n = 19; 14Fr, n = 22).

Result: A total of 102 patients had immediate femoral vein hemostasis, and 2 developed a femoral vein hematoma requiring manual compression. One patient was diagnosed with a femoral artery pseudoaneurysm during hospitalization. On follow-up, there was no evidence of hematoma or thrombosis.

Conclusion: The "figure-of-eight" suture technique is effective and safe, achieving immediate hemostasis after the use of large femoral vein sheaths in children.

Keywords: Femoral Vein; Hemostasis; Structural Heart Disease.

MeSH terms

  • Aneurysm, False / etiology
  • Angioplasty, Balloon / adverse effects
  • Angioplasty, Balloon / instrumentation
  • Angioplasty, Balloon / methods*
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / methods*
  • Cardiac Catheters
  • Child
  • Child, Preschool
  • Equipment Design
  • Female
  • Femoral Vein*
  • Heart Septal Defects, Atrial / diagnosis
  • Heart Septal Defects, Atrial / therapy*
  • Hematoma
  • Hemorrhage / diagnosis
  • Hemorrhage / etiology
  • Hemorrhage / prevention & control*
  • Hemostatic Techniques* / adverse effects
  • Humans
  • Male
  • Pulmonary Valve Stenosis / diagnosis
  • Pulmonary Valve Stenosis / therapy*
  • Punctures
  • Suture Techniques* / adverse effects
  • Time Factors
  • Treatment Outcome
  • Vascular System Injuries / etiology