Femoral Venous Access Technique and Vascular Closure for Left Atrial Appendage Occluder Implantation

Safe and effective management of vascular access is an essential aspect of the left atrial appendage occlusion (LAAO) procedure. Vascular complications can lead to considerable morbidity and mortality. Strict adherence to best practices and meticulous attention to detail have been shown to reduce both the likelihood of vascular complication as well as procedure times, with a positive impact on patient satisfaction, comfort, and safety. Use of a micropuncture technique with ultrasound (US) guidance has been associated with reduced complications and is considered best practice for LAAO. Following LAAO, hemostasis may be obtained using a variety of techniques including manual compression, vascular closure devices (VCD), and figure-of-8 skin sutures. Closure techniques are plentiful and vary among different institutions and practitioners. Given a lack of formal data to support one technique over another, a personalized approach to care, with consideration of each patient’s unique risk factors and future healthcare needs, remains the best practice.