Improved hybrid technique for vascular access and closure

Purpose: To present a technique for vascular access that features minimal surgical visualization of the target vessel, fast and safe access using an open Seldinger technique under tactile and visual control, and suture closure. Technique: After minimal surgical access to the target vessel, exposing only the anterior wall, 4 preliminary 5-0 polypropylene transmural single sutures are placed in the horizontal plane, 2 on either side of the proposed entry point. If the anterior wall is calcified, the sutures are placed more laterally or medially in a suitable plaque-free area. The vessel is then accessed via an open Seldinger technique in the midline between the 4 sutures, and the corresponding sheaths are inserted over the wire. At the end of the procedure, the sheath and wire are removed, and with digital pressure on the vessel distally, the access site is washed out in antegrade fashion. All 4 sutures are then pulled tight by an assistant, and the surgeon ties all the sutures sequentially. Over a 4-year period, this technique has been used in 536 accesses involving the common femoral (n=500) and iliac (n=32) arteries and the abdominal aorta (n=4). Up to 24-F sheaths were introduced. Mean time for vascular access was 9.0 +/- 3.3 minutes. There were no access-related early complications detected in routine postprocedural imaging and clinical evaluation. Conclusion: The "Surgiclose" technique, which is easy to learn and applicable to all vessels, provides a fast, easy, and reliable remote vascular access. It combines the best of both surgical and interventional access techniques, affording minimal surgical access and maximal safety.