Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 5, October 2019, pages 303-308

Efficacy and Safety of Subcutaneous Fellow’s Stitch Using “Fisherman’s Knot” Technique to Achieve Large Caliber (> 10 French) Venous Hemostasis

Figures

Figure 1.
Figure 1. Point of entry of sheath into skin.
Figure 2.
Figure 2. First pass of suture by crossing below the sheath and skin caudal to entry point (a). The needle and suture were crossed over the sheath and making second pass (b).
Figure 3.
Figure 3. The entry, exit and course of suture imparted a figure of Z (a). Both the free ends were then tied using fisherman’s knot over the entry point of sheath giving it appearance of figure-of-eight (FoE; b).
Figure 4.
Figure 4. After first knot, sheath was pulled out gently and removed (a). Following removal of sheath, few more (3 - 4) reinforcement knots were tied, thus tightening the suture so that subcutaneous tissue was folded up achieving immediate hemostasis (b).
Figure 5.
Figure 5. The basic steps of the fellow’s stitch using fisherman’s knot.

Tables

Table 1. Baseline Characteristics of Patients (n = 749)
 
VariablesGroup I (fellow’s stitch; n = 384)Group II (manual compression; n = 365)
ASD: atrial septal defect; PTMC: percutaneous transmitral commissurotomy; PDA: patent ductus arteriosus; BPV: balloon pulmonary valvuloplasty; RSOV: ruptured sinus of Valsalva aneurysm; VKA: vitamin K antagonist.
Sex (male/female)249 (65%)/135 (35%)226 (62%)/139 (38%)
Procedures
   ASD105 (27%)93 (25%)
   PTMC240 (63%)235 (64%)
   PDA23 (6%)20 (5%)
   BPV12 (3%)13 (5%)
   RSOV4 (1%)4 (1%)
Sheath size
  10 Fr76 (19.7%)70 (19.1%)
  12 Fr274 (71.4%)263 (72.2%)
  14 Fr34 (8.9%)32 (8.7%)
Previous VKA37 (9.6%)31 (8.4%)

 

Table 2. Procedural Outcome of Patients (n = 749)
 
VariablesGroup I (n = 384; %)Group II (n= 365; %)P value
AV: arterio-venous.
Immediate closure343 (89.3)
Delayed closure (2 min)41 (10.7)
Time to hemostasis (min)1.114.30.004
Time in recovery room (min)2.221.60.003
Ambulation time (h)3.318.90.005
Cross-over5 (1.3)00.002
Hospital stay (h)24.636.80.005
Immediate complications
  Hematoma1 (0.2)6 (1.6)0.005
  Re-bleeding5 (1.3)7 (1.9)0.06
Delayed complications
  AV fistula000.5
  Thrombosis04(1.1)0.005