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AJNR - American Journal of Neuroradiology

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Neurointerventional Experience with an Arteriotomy Suture Device

P. Pearse Morris^,a and Gregory Braden^a

^a From the Department of Radiology (P.M.) and the Section of Interventional Cardiology (G.B.), Wake Forest University School of Medicine.

View larger version (33K): [in a new window]   FIG 1. The device resembles a J-shaped 40-cm sheath with hydrophilic coating. It is inserted over a wire into the artery. Package also includes a knot pusher used for achieving tight closure of sutures under subcutaneous tissues

View larger version (149K): [in a new window]   FIG 2. Hub of the device features a translucent ring handle for retracting the needles out of the shaft. A clear marker tubing (white arrow) emits pulsatile flow of blood when device is fully in position within vessel. Prior to deployment of the needles, slack from sutures is housed within two other clear tubings (black arrowheads) extending from the hub

View larger version (74K): [in a new window]   FIG 3. After anesthetization of groin area with lidocaine and epinephrine, the device is dissected through the subcutaneous tissues until the narrow shaft is fully within the lumen of the artery. A hole near end of shaft allows escape of arterial flow into the clear tubing extending from hub (white arrow in 2), to indicate to the operator that the device is in place

View larger version (187K): [in a new window]   FIG 4. A and B, Needles are retracted from shaft by pulling on ring handle. As they emerge from shaft (close-up view A), needles bevel away from shaft so as to pierce edges of the arteriotomy site, and then enter the hub. Then they emerge from hub with suture strings attached (black arrowhead in B). A forceps is used to withdraw needles and sutures from hub completely. Note that thread is attached to the end of needle, which emerges first from the hub (arrow)

View larger version (51K): [in a new window]   FIG 5. A and B, needles are cut from sutures and the device is withdrawn partially to give the operator control of sutures on the arterial side of hub. An improved clinch knot (A) or a series of surgeon's knots are applied loosely and tightened against the arterial wall as the device is withdrawn from artery (B). The knot pusher can be used then to tighten the knot