Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures

Mark T Mills; Peter Calvert; Richard Snowdon; Saagar Mahida; Johan Waktare; Zoltan Borbas; Reza Ashrafi; Derick Todd; Simon Modi; Vishal Luther; Dhiraj Gupta

doi:10.1111/jce.16417

Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures

J Cardiovasc Electrophysiol. 2024 Nov;35(11):2119-2127. doi: 10.1111/jce.16417. Epub 2024 Sep 4.

Authors

Mark T Mills^{1

2}, Peter Calvert^{1

2}, Richard Snowdon¹, Saagar Mahida¹, Johan Waktare¹, Zoltan Borbas¹, Reza Ashrafi¹, Derick Todd¹, Simon Modi¹, Vishal Luther^{1

2}, Dhiraj Gupta^{1

2}

Affiliations

¹ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
² Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.

PMID: 39233396
DOI: 10.1111/jce.16417

Abstract

Background and aims: Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture-based techniques such as a figure-of-eight suture secured with a hand-tied knot (Fo8_HT) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8_MOD). We hypothesised that short-term bleeding outcomes using the Fo8_MOD approach would be superior to MC. We additionally compared outcomes between Fo8_MOD and Fo8_HT approaches.

Methods: We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8_HT and Fo8_MOD. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression).

Results: 1089 patients were included: MC 718 (65.9%); Fo8_HT 105 (9.6%); Fo8_MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re-entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8_MOD associated with fewer complications than MC or Fo8_HT (major: MC 2.2%, Fo8_HT 6.0%, Fo8_MOD 0.8%, p = .01; minor: MC 16.5%, Fo8_HT 12.0%, Fo8_MOD 7.4%, p = .002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p = .729 for between groups rates). On multivariable logistic regression, Fo8_MOD was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17-0.48], p < .001), whilst intraprocedural heparinisation (OR 5.25 [2.88-9.69], p < .001) and larger maximal sheath size (OR 1.06 [1.00-1.11], p = .04) were associated with a higher risk of complications.

Conclusion: Femoral haemostasis with Fo8_MOD associates with fewer access site complications than MC and Fo8_HT following EP procedures that need periprocedural anticoagulation.

Keywords: Catheter ablation; electrophysiology; femoral haemostasis; figure‐of‐eight suture; vascular complications.

Publication types

Comparative Study

MeSH terms

Aged
Catheter Ablation / adverse effects
Catheterization, Peripheral / adverse effects
Electrophysiologic Techniques, Cardiac
Female
Femoral Vein* / surgery
Hemorrhage / etiology
Hemorrhage / prevention & control
Hemostatic Techniques* / adverse effects
Hemostatic Techniques* / instrumentation
Humans
Male
Middle Aged
Pressure
Punctures*
Retrospective Studies
Risk Factors
Suture Techniques* / adverse effects
Time Factors
Treatment Outcome