title: Permacol (porcine dermal collagen) and Alloderm (acellular cadaveric dermis) as a vascular patch repair for common carotid arteriotomy in a rabbit model.
abstract: Occult injuries to arteries are common in trauma and evolution of their repair has been observed throughout military conflicts. Currently, autogenous vein and polytetrafluoroethylene (PTFE) are used as patch agents for arterial trauma. However, suitable vein is often lacking in multitrauma patients, and PTFE is prone to infection in the contaminated combat wound. The purpose of this study is to evaluate Permacol, porcine dermal collagen, and Alloderm, acellular cadaveric dermis, as suitable alternatives to PTFE with the potential benefit of being used in contaminated wounds. A New Zealand White rabbit common carotid arteriotomy model was used to compare Permacol (n = 12), Alloderm (n = 11), and PTFE (n = 13) for patch repair. Thrombin generation was examined using an enzyme-linked immunosorbent assay for thrombin-antithrombin complex. Histological samples were taken to analyze vessel lumen area, vessel diameter, intimal thickness, and medial thickness. Pathological examinations were made to compare rates of intimal hyperplasia, aneurysm, patency, and thrombus formation. The Permacol group showed equivalent rates of thrombus, aneurysm, and patency compared with PTFE. Increased lumen area was seen in the Permacol group, 0.344 mm2 (p = 0.02) compared with the PTFE group, 0.204 mm2. Permacol also had decreased incidence of intimal hyperplasia compared with PTFE, 50.0% versus 92% (p < 0.05). Alloderm had increased rates of aneurysm formation, 63.6% (p = 0.004) compared with PTFE, 0.0%, and Permacol groups, 8.3%. Alloderm also had increased intimal thickness through the patch, 0.076 mm (p = 0.18), compared with PTFE, 0.026 mm, and Permacol groups, 0.024 mm. Vessel diameter through the patch showed the Alloderm group, 1.87 mm (p = 0.004), was significantly larger than both the Permacol, 1.41 mm, and PTFE groups, 1.28 mm. Furthermore, Alloderm showed leukocyte migration around the patch. Enzyme-linked immunosorbent assay for thrombin-antithrombin complex was only elevated for PTFE in the 7-day postoperative measurement but was not statistically different from the other groups. Permacol has characteristics to be an effective alternative for PTFE for patch arteriotomy repair in our rabbit model. Futher studies need to be conducted to investigate the potential of Permacol in vascular trauma. Alloderm is not a suitable alternative to PTFE for patch arteriotomy repair.
authors.affiliation: Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia 30905, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Tsai
authors.forename: Farhan S
authors.initials: FS
authors.lastname: Ayubi
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rice
authors.forename: Zhou
authors.initials: Z
authors.lastname: Zhang
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Armstrong
mesh_terms: D000783:Aneurysm / Q000209:etiology; D000818:Animals; D000990:Antithrombin III; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002102:Cadaver; D017536:Carotid Artery, Common / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003094:Collagen; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008422:Materials Testing; D023421:Models, Animal; D010447:Peptide Hydrolases / Q000097:blood; D011474:Prosthesis Design; D011817:Rabbits; D013552:Swine; D013927:Thrombosis / Q000097:blood / Q000209:etiology; D013997:Time Factors; D014654:Vascular Patency; D014945:Wound Healing
chemical_list: C440568:Alloderm; C422414:Permacol; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D003094:Collagen; D010447:Peptide Hydrolases