Jugular Vascular Closure and Scar Formation after Leadless Pacemaker Implantation

Shmaila Saleem-Talib; Crispijn P R Hoevenaars; Vincent J van Driel; Harry van Wessel; Jeroen van der Heijden; Hemanth Ramanna; Natasja M S de Groot

doi:10.31083/j.rcm2512440

Jugular Vascular Closure and Scar Formation after Leadless Pacemaker Implantation

Rev Cardiovasc Med. 2024 Dec 16;25(12):440. doi: 10.31083/j.rcm2512440. eCollection 2024 Dec.

Authors

Shmaila Saleem-Talib¹, Crispijn P R Hoevenaars¹, Vincent J van Driel¹, Harry van Wessel¹, Jeroen van der Heijden¹, Hemanth Ramanna^{1

2}, Natasja M S de Groot³

Affiliations

¹ Department of Cardiology, Haga Teaching Hospital, 2545AA The Hague, The Netherlands.
² University of Applied Sciences of The Hague, 2521EN The Hague, The Netherlands.
³ Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands.

Abstract

Background: Achieving hemostasis of large bore venous access sites can be challenging and time consuming. Closure devices have proven to be superior in achieving hemostasis, reducing time to ambulation and improving patient comfort, compared to manual hemostasis techniques after femoral venous and arterial access. The closure of the jugular vein following large bore access has not been investigated in previous studies. In addition, scar formation of the neck after large bore access of the jugular vein has not been investigated. In this study, the safety and feasibility of the double Perclose ProGlide (PP), for achieving hemostasis of the internal jugular vein (IJV) following large bore access with 27 French Micra Transcatheter Pacemaker System (TPS) was examined. Also, the scar formation in the neck after IJV closure was examined during follow-up.

Methods: 136 consecutive patients from May 2018 until June 2024, in whom the IJV was closed with a double PP, following Micra TPS implantation were included. All patients were examined for hemostasis of the IJV and vascular complications, resulting in additional interventions. Time to ambulation, discharge and patient discomfort were also assessed. During follow-up the scar formation of the neck was examined.

Results: In all patients, the double PP was successful in achieving acute hemostasis of the IJV after large bore access. In all patients, 2 PP were deployed without device failure. One patient required additional manual pressure due to a minor hematoma. Ultrasound guided examination did not reveal any vascular complications. All patients were ambulated immediately. During follow-up, the scar in the neck was hardly visible.

Conclusions: Although the PP was designed as a closure device for femoral venous and arterial access, our data suggest that the PP can be used safely as a closure device for the IJV to achieve acute hemostasis, facilitate direct ambulation and improve patient comfort.

Keywords: Micra; Perclose ProGlide; jugular vein; large bore vascular access; leadless pacemaker; vascular closure device.