CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S2
DOI: 10.1055/s-0041-1730648

Fistula Access Site Hemostasis: a Sticky Solution to a Bloody Problem

M R Akhtar
The Royal London Hospital, Whitechapel, London, UK
A Zaman
The Royal London Hospital, Whitechapel, London, UK
T Fotheringham
The Royal London Hospital, Whitechapel, London, UK
› Author Affiliations

Background: Histoacryl (glue) is well established as an agent for hemostasis for small subcutaneous lacerations and wounds in the emergency department. We translate this well-established technique into the interventional radiology world, using it for achieving hemostasis of hemodialysis arteriovenous fistula (AVF) access sites after percutaneous interventions. We audit the effectiveness, safety, and patient acceptability of this technique to conventional suturing closure methods. Methods: We carried out an audit of the use of skin adhesives (Histoacryl®) to close fistula access sites versus conventional surgical suturing in our large tertiary care center where there is a variety of different preferred techniques on wound closure. Thirty-nine procedures were performed on 33 patients who underwent percutaneous intervention of failing or thrombosed AVFs. In total, there were 39 access sites. Postprocedure hemostasis was achieved using Histoacryl® on 25 access sites, while surgical suturing was used for 14 access sites. Procedure details, including time to hemostasis, size of access sheath, dose and time of heparin administration, immediate complications, and patient self-reporting numeric pain intensity scale (0–10), were all recorded. Results: Histoacryl® group had a mean pain rating of 0.4 (standard deviation [SD] 0.7), and the suturing group had a mean pain rating of 2.6 (SD 0.7). Meantime to achieve hemostasis was 92 s in the Histoacryl® group (range: 20–601 s) and 198 s in the suture group (range: 58–361 s). No immediate complications were reported in either group. Conclusion: This audit has shown that Histoacryl® offers a fast, technically simple, device/suture-free, and painless technique for acquiring hemostasis after AVF intervention.

Publication History

Article published online:
11 May 2021

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