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Percutaneous vascular surgery (PVS) device positioning, needle and suture deployment, and knot advancement. At the end of the diagnostic or interventional catheterization procedure, the artery sheath is removed and the PVS device is introduced into the femoral artery over a guidewire. The barrel of the device, which receives needles after deployment, rotates, facilitating introduction of the device. Appropriate positioning is indicated by a pulsatile flash of blood from the marker lumen exiting the proximal section of the device. The lumen communicates with a small port which, when positioned intraluminally, permits backbleeding through the lumen. Needle tips are located distal to the marker port; thus, the flash of blood from the marker lumen indicates the needle tips are intraluminal and correctly positioned to capture arterial tissue. Needles and sutures are deployed by unlocking and pulling the ring handle. Once deployed, the needles are removed from the device and cut from the sutures. A square knot is tied and then advanced with a knot pusher to the surface of the artery while the device is simultaneously removed. Guidewire access may be maintained until hemostasis is confirmed. Once hemostasis is achieved, overhand throws are advanced to secure the position of the square knot. The sutures are then trimmed below the skin and a sterile dressing is applied to cover the access site.
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