Minimalist Method For Explantation Of Percutaneous Large- Caliber Venous Cannulas: Horizontal- Cutaneous Mattress Stitch
Anas Sassi, Nicolas Murith, Raphael Giraud, Damiano Mugnai, Burak Depboylu, Stephane Noble, Christoph Huber, Mustafa Cikirikcioglu.
University Hospitals of Geneva, Geneva, Switzerland.
BACKGROUND: The large-bore catheters used for peripheral venous cannulation during minimal invasive heart operations or peripheral extra-corporeal-membrane-oxygenation (ECMO). Although the percutaneous implantation technique is standardized by Seldinger method, there are different alternatives used to close the venous access at the end of procedure i.e. local compression, surgical approach and direct vein suturing or percutaneous suturing by vascular closure systems. Here we report the results of our simple technique for closure of large-bore percutaneous venous access following our ECMO weaning protocols. METHOD: The above mentioned technique based on a cutaneous horizontal mattress stitch made by a large needle poly-filament suture (Vicryl-1CT) which passes around the venous line entry point before explantation (Figure 1-A). Following the ablation of the venous cannula, this stich is tied gently and the groin is compressed for 10 minutes (Figure 1-B). The cutaneous cut is closed by two intradermal absorbable simple stitches (Monocryl-4/0) for better skin healing. The horizontal mattress stitch left on place for 48-hours. RESULTS: This technique is used in our Division on 23 consecutive patients who had percutaneous ECMO implantation (venous cannula size-25 French for 22 patients and 23 French for one patient). All patients were therapeutically anticoagulated at the moment of ablation, 8 patients were therapeutically anticoagulated even after decannulation. Six patients had dual anti-platelet treatment because of coronary stent implantations. We reported no complications (bleeding, infection, pseudo-aneurysm formation, or complicated wound healing) (Figure 1-C). CONCLUSION: Closure of large-calibre percutaneous venous access following minimal invasive heart operations or ECMO weaning using of horizontal mattress stitch is safe and effective method despite even having perioperative antiplatelet and anticoagulant treatments. This technique gives a perfect wound healing without adding additional costs and by preventing the possible complications related with venous line explantation. 
LEGEND - Horizontal-cutaneous mattress stitch technique FIGURE 1- A- Cutaneous horizontal mattress stitch made by a large needle poly-filament suture (Vicryl-1CT) which passes around the venous line entry point before explantation. B- Following the ablation of the venous cannula, this stich is tied gently and the groin is compressed for 10 minutes. C- Picture shows following ablation of the horizontal mattress stitch, perfect wound healing without having any local complication.
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