The potential utility of fibrin sealant dressing in repair of vascular injury in swine.
BACKGROUND
A previous study in which fibrin sealant dressing (FSD) secured hemostasis in major arterial hemorrhage for 96 hours suggested the applicability of this dressing in damage control operations after severe trauma. The objective of this study was to determine the effective duration of FSD hemostatic function in vivo and to examine its potential utility for definitive repair of a major arterial injury in swine.


METHODS
High pressure bleeding in an infrarenal aortotomy was controlled by placing FSD on the wound with 4-minute compression (n = 15). If hemostasis was achieved, the abdominal cavity was closed. Surviving animals were killed at 2, 4, 6, and 8 weeks and aortotomy sites collected for histology.


RESULTS
FSD stopped arterial hemorrhage after 4-minute compression in 14 of 15 (93%) pigs. Dressings failed in two pigs at 36 and 53 minutes after treatment. Twelve (80%) animals recovered and resumed normal activities. Of the remaining 12, two developed rebleeding at the aortotomy site on days 8 and 11 and were killed; another was killed because of idiopathic low hematocrit on day 10. Nine pigs survived until scheduled to be killed, maintaining hemostasis with stable hematological values. In the surviving animals, serial computed tomography scans showed formation of a pseudoaneurysm at the aortotomy site, which resolved after 2 to 3 weeks. The initial vascular defect and pseudoaneurysm were filled with fibroblast-myoblast collagen rich tissues covered by endothelium.


CONCLUSIONS
FSD can seal an arterial injury, stop high pressure bleeding, and prevent rebleeding for at least 7 days. The dressing may be most beneficial in damage control operations. If combined with an elective interventional radiologic procedure (e.g. embolization or stenting), it may also offer an alternative to suture repair of vascular injuries in cases where profuse bleeding obstructs visualization.
Kheirabadi
Bijan S
BS
United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. bijan.kheirabadi@cen.amedd.army.mil
Acheson
Eric M
EM
Deguzman
Rodolfo
R
Crissey
Jacqueline M
JM
Delgado
Angel V
AV
Estep
Scot J
SJ
Holcomb
John B
JB
D000704:Analysis of Variance; D000818:Animals; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006470:Hemorrhage / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D009779:Occlusive Dressings; D013552:Swine; D014057:Tomography, X-Ray Computed; D014945:Wound Healing
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics