Angiographic Changes following the Use of a Purse-String Suture Hemostasis Device in Hemodialysis Access Interventions

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To evaluate late angiographic changes at the puncture site with use of a suture lock device for hemostasis after hemodialysis access interventions. Thirty-five patients who underwent percutaneous intervention of a failing or thrombosed access had 76 puncture sites (58 grafts, 15 fistulas, three composite) managed with a purse-string suture lock device. All patients had follow-up fistulograms available for analysis. Fistulograms at the site of sheath insertion were retrospectively compared with those obtained during subsequent hemodialysis access procedures to assess for changes in access lumen diameter. Access type, sheath size, and heparin dose were examined as predictors of access diameter change at the puncture site. The mean time to follow-up fistulography was 4.7 months; the cumulative observation time of the patient cohort was 30.5 dialysis years. The mean change in access diameter at the previous puncture site was -0.3%. No puncture sites became aneurysmal or stenotic during follow-up. Two of the 76 puncture sites (both grafts) developed mild (+28%) and moderate (+43%) bulging at the sheath site. The remaining 74 puncture sites (97%) showed no significant change in access diameter. The mean change in access diameter among fistulas was -6.2%, and that among grafts was +1.5% (P = .06). Neither sheath size (P = .26) nor heparin dose (P = .48) had an effect on access diameter. No patients developed aneurysms or stenosis at the puncture site after use of a suture lock device for hemostasis. This technique is consistent, safe, and effective in obtaining hemostasis after dialysis access interventions of fistulas and grafts.