Fibrin glue sealing of polytetrafluoroethylene vascular graft anastomoses: comparison with oxidized cellulose.
To evaluate potential clinical applications of nonautologous fibrin glue (FG) as a hemostatic agent in vascular surgery, we compared its efficacy to oxidized regenerated cellulose (OC) in hemostatically sealing polytetrafluoroethylene (PTFE) vascular graft anastomoses. PTFE grafts (4 mm wide and 4 to 6 cm in length) were placed to each femoral artery in a heparinized canine model, in end-to-end fashion in half of the dogs and in end-to-side fashion in the remaining dogs. Each set of graft-arterial anastomoses was then sealed with either FG or OC, determined randomly, followed by simultaneous measurement of blood loss through the graft anastomoses and needle holes. There was significantly less bleeding from anastomoses sealed with FG compared with those sealed with OC, regardless of whether the anastomoses sealed with FG compared with those sealed with OC, regardless of whether the anastomosis was constructed in end-to-end (p less than 0.03) or end-to-side (p less than 0.004) fashion; overall, the operative blood loss for grafts sealed with FG was 14 +/- 6 (mean +/- standard error of the mean) vs 99 +/- 27 ml/min for those sealed with OC (p less than 0.001). In the early postoperative period, significant groin hematomas occurred more frequently in grafts sealed with OC compared with those sealed with FG. Microscopic examination of graft-arterial specimens harvested at postoperative intervals ranging from 1 day to 3 months revealed no significant inflammatory reaction with either hemostatic agent; after 2 to 3 weeks, paired specimens appeared histologically similar despite previous treatment with either FG or OC.(ABSTRACT TRUNCATED AT 250 WORDS)
Kram
H B
HB
Department of Surgery, King-Drew Medical Center, Los Angeles, CA 90059.
Nugent
P
P
Reuben
B I
BI
Shoemaker
W C
WC
D000714:Anastomosis, Surgical; D000818:Animals; D007611:Aprotinin; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis; D002482:Cellulose / Q000031:analogs & derivatives; D002483:Cellulose, Oxidized; D004285:Dogs; D004338:Drug Combinations; D005176:Factor XIII; D005263:Femoral Artery / Q000473:pathology / Q000601:surgery*; D005337:Fibrin; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen; D006470:Hemorrhage / Q000209:etiology; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D011897:Random Allocation; D013917:Thrombin; D014014:Tissue Adhesives; D014654:Vascular Patency; D014945:Wound Healing
D001672:Biocompatible Materials; D002483:Cellulose, Oxidized; D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; C013695:Surgicel; D005337:Fibrin; D005340:Fibrinogen; D011138:Polytetrafluoroethylene; D002482:Cellulose; D005176:Factor XIII; D007611:Aprotinin; D013917:Thrombin