Vascular closure devices (VCDs) like the Perclose ProStyle Suture® offer quicker hemostasis and ambulation after percutaneous procedures. However, we are seeing a concerning rise in reports of infected pseudoaneurysms associated with their use, particularly at the umbilical depression- the puncture site. Current techniques often fail to address the underlying biomechanical issue that predisposes patients to infection. The published case study details a simple, yet ingenious, "restoration" technique that could significantly reduce these complications. Let's examine whether this approach holds water.
The authors highlight that the Perclose device, while effective, can create an inward depression at the puncture site. This depression collects fluid and debris, fostering a prime environment for bacterial colonization and subsequent infection. The proposed solution? A meticulous, layered closure that restores the natural contour of the abdominal wall, thereby eliminating the depression and promoting proper wound healing.
Clinical Key Takeaways
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- The PivotStandard VCD deployment focuses on immediate hemostasis. This technique shifts the focus to long-term wound biomechanics to prevent infection.
- The DataThe case study demonstrated successful resolution of an infected pseudoaneurysm with the restoration technique, eliminating the umbilical depression and promoting healing. While a single case, it highlights a potential mechanism.
- The ActionWhen using the Perclose ProStyle, consider a layered closure technique to evert the skin edges and eliminate any residual depression at the puncture site. This may require additional sutures beyond the VCD itself.
The Problem: Umbilical Depression and Infection Risk
The biomechanics are fairly straightforward. The Perclose ProStyle, designed to approximate tissue for hemostasis, can inadvertently create an invagination, or what the authors term an "umbilical depression," at the puncture site. This depression acts as a reservoir, collecting bodily fluids, blood, and skin flora. This creates a perfect micro-environment for bacterial proliferation, increasing the risk of surgical site infection (SSI) and, in severe cases, infected pseudoaneurysms. It's a simple matter of physics: stagnant fluid equals increased infection risk.
The Restoration Technique: A Layered Approach
The proposed "restoration" technique addresses this biomechanical flaw directly. Instead of relying solely on the Perclose suture, the authors advocate for a meticulous, layered closure. This involves using additional sutures to re-approximate the subcutaneous tissue, effectively everting the skin edges and eliminating the umbilical depression. The goal is to restore the natural contour of the abdominal wall, promoting drainage and preventing fluid accumulation. It's analogous to ensuring a proper seal on a wound; you wouldn't leave a pocket for infection to brew.
Guideline Alignment or Departure?
Current guidelines, such as those from the Society for Vascular Surgery (SVS), emphasize the importance of aseptic technique and prompt treatment of surgical site infections. However, they do not specifically address the biomechanical factors contributing to infection risk associated with VCDs. This "restoration" technique, while not explicitly mentioned in guidelines, aligns with the broader principle of optimizing wound healing and preventing complications. The 2016 SVS guidelines on management of pseudoaneurysms do mention surgical repair as a treatment option, but this innovative approach aims for prevention, not just intervention (Conte et al., 2016).
Study Limitations
Let's be clear: this is a single case report. We cannot draw broad conclusions about the efficacy of this technique based on one patient. A prospective, randomized controlled trial would be needed to definitively demonstrate its benefit. Furthermore, the authors do not provide detailed information on the types of sutures used, the specific suturing technique, or the long-term outcomes. We also do not know the BMI of the patient, which is a critical risk factor for wound healing. Without standardization and rigorous evaluation, it's difficult to determine if this technique is truly superior to standard closure methods.
If this technique proves effective, it could reduce the incidence of infected pseudoaneurysms, leading to fewer readmissions and lower healthcare costs. However, the implementation of this technique may require additional time and resources. Surgeons may need to use more suture material and spend more time closing the puncture site. This increased procedure time could translate to higher costs, particularly in settings where operating room time is at a premium. Furthermore, reimbursement for this "restoration" technique may be a challenge, as it's not a separately billable procedure. Hospitals may need to absorb the additional costs or find ways to justify the expense based on reduced readmission rates. The economic realities are that infection control is a profit center and nobody gets promoted for preventing things.
LSF-8801913014 | January 2026
How to cite this article
MacReady R. A simple restoration technique for perclose-related infections. The Life Science Feed. Published January 7, 2026. Updated January 7, 2026. Accessed January 31, 2026. .
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Fact-Checking & AI Transparency
This summary was generated using advanced AI technology and reviewed by our editorial team for accuracy and clinical relevance.
References
- Conte, M. S., Pomposelli, F. B., Clair, D. G., Geraghty, P. J., Giangola, G., Goines, T., ... & Society for Vascular Surgery. (2016). Society for Vascular Surgery practice guidelines for management of arterial pseudoaneurysms. Journal of Vascular Surgery, 63(5), 1233-1259.
- Mujtaba, M. A., Lattimer, C. R., Riaz, M. Y., & Cheema, F. T. (2023). Infected Pseudoaneurysm Associated With Umbilical Depression at the Puncture Site Due to Perclose ProStyle Suture®: Restoration for Infection Prevention. Cureus, 15(12).
- нацыянальны цэнтр аховы здароўя. (n.d.). Surgical Site Infections. CDC. Retrieved from https://www.cdc.gov/hai/ssi/index.html
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