Safety and efficacy of suture-mediated closure after percutaneous coronary interventions

Catheter Cardiovasc Interv. 2001 Oct;54(2):146-51. doi: 10.1002/ccd.1256.


Percutaneous coronary interventions (PCI) performed with concomitant use of heparin and platelet inhibitors are safe procedures with reported vascular complication rates of approximately 6.1%. EPILOG investigators demonstrated that utilizing a low-dose heparin regimen with abciximab, along with early sheath removal, vascular access-related bleeding was significantly lower than that reported in EPIC. Recently, a suture-mediated closure (SMC) device has been reported to be safe, appears effective, and may improve patient comfort by allowing early ambulation. We conducted a retrospective analysis (January 1999 to March 2000) of complication frequencies among PCI patients who underwent SMC and those who had manual compression (non-SMC). Furthermore, we compared the overall rates of complications to patients who underwent PCI prior to the introduction of SMC (1995-1998). When comparing the current cohort to the historical cohort, there was a significant decrease in the number of retroperitoneal bleeds (0.3% vs. 0.9%; P = 0.003), hematomas (5% vs. 9%; P < 0.001), pseudoaneurysms (1.2% vs. 2.7%; P < 0.001), and need for vascular surgery (0.9% vs. 2.8%; P < 0.001). There was no difference in the number of arterio-venous fistulas and a slight increase in transfusion needs (12% vs. 10%; P = 0.03). Within the current cohort, there was no difference in the vascular complications between SMC and non-SMC PCI patients, although there were lower rates of pseudoaneurysms (0.5% vs. 1.8%; P = 0.02) and transfusion requirements (72/880 vs. 132/874; P < 0.001). These results suggest that the complication rates for SMC are not different and may be lower when compared to non-SMC patients after PCI. At our institution, the practice of early sheath removal and less aggressive heparin dosing has led to a decrease in vascular complication rates and a 66% reduction in vascular surgeries on post-PCI patients. Because of the limitations of retrospective analyses, further studies will be necessary to confirm these findings.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aneurysm, False / etiology*
  • Aneurysm, False / surgery
  • Angioplasty, Balloon, Coronary*
  • Arteriovenous Fistula / etiology*
  • Arteriovenous Fistula / surgery
  • Blood Transfusion
  • Cohort Studies
  • Coronary Disease / therapy*
  • Early Ambulation
  • Female
  • Hematoma / etiology*
  • Hematoma / surgery
  • Hemorrhage / etiology*
  • Hemorrhage / surgery
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Suture Techniques / adverse effects*
  • Suture Techniques / instrumentation*
  • Treatment Outcome
  • Vascular Diseases / etiology*
  • Vascular Diseases / surgery
  • Vascular Surgical Procedures