COLLAGEN PLUG HEMOSTATIC CLOSURE OF FEMORAL ARTERIAL PUNCTURE SITES FOLLOWING IMPLANTATION OF INTRACORONARY STENTS

Recently a new adjunct to achieving arterial hemostasis has been devel oped. The device consists of a purified bovine collagen plug which whe n inserted adjacent to the arterial wall induces the formation of a he mostatic cap directly over the arterial puncture. We have utilized col lagen plug hemostasis in 32 patients on 35 occasions undergoing implan tation of intracoronary stents while attempting to maintain continuous full anticoagulation. Initial hemostasis was successfully achieved in all patients. Moderate sized (5 to 10 cm) hematomas were noted in 4 p atients and large hematomas (>10 cm) in 3, of whom 2 required vascular repair and transfusion. One patient developed a purulent discharge fr om the puncture site which resolved with a brief course of antibiotics . No patient suffered femoral arterial occlusion, distal embolization, or venous thrombosis. There were no long term access site problems at a mean follow up of 6 months. Repeat catheterization utilizing the sa me femoral artery was performed in 16 patients without difficulty. In five of these patients angiography was performed early after stent imp lantation without discontinuation of full anticoagulation and collagen closure was utilized a second time. Collagen plug hemostasis is feasi ble after coronary stenting, may allow more aggressive anticoagulation than might otherwise be achieved, and may facilitate angiographic res tudy early after stenting without the need to discontinue anticoagulat ion. (c) 1993 Wiley-Liss, Inc.