title: The efficacy of hemostatic techniques in the sheep model of carotid artery injury.
abstract: BACKGROUND
  The most dramatic complication in endonasal surgery is inadvertent injury to the internal carotid artery (ICA) with massive bleeding. Nasal packing is the favored technique for control; however, this often causes complete carotid occlusion or carotid stenosis, contributing to the morbidity and mortality of the patient. The aim of this study is to compare the efficacy of endoscopically applied hemostatic techniques that maintain vascular flow in an animal model of carotid artery injury.
  
  
  METHODS
  A total of 20 sheep underwent ICA dissection/isolation followed by the placement of the artery within a modified "sinus model otorhino neuro trainer" (SIMONT) model. A standardized 4-mm carotid artery injury was created endoscopically. Randomization of sheep to receive 1 of 5 hemostatic techniques was performed (Floseal, oxidized regenerated cellulose, Chitosan gel, muscle patch, or the U-Clip anastomotic device). Specific outcome measures were time to hemostasis, duration of time mean arterial pressure (MAP) was >55 mmHg, blood loss, and survival time.
  
  
  RESULTS
  Muscle patch hemostasis and the U-Clip anastomotic device were significantly more effective at achieving primary hemostasis rapidly, reducing total blood loss, and increasing survival time and time MAP was >55 mmHg more than Floseal, oxidized regenerated cellulose, and Chitosan gel (p < 0.05). Additionally, all muscle patch-treated and U-Clip device-treated sheep achieved primary hemostasis and reached the endpoint of observation, while maintaining vascular patency. Floseal and oxidized regenerated cellulose failed to achieve hemostasis in any animal, with all animals exsanguinating prematurely.
  
  
  CONCLUSIONS
  In the sheep model of endoscopic ICA injury, the muscle patch and U-Clip anastomotic device significantly improved survival, reduced blood loss, and achieved primary hemostasis while maintaining vascular patency.
authors.affiliation: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Valentine
authors.forename: Sam
authors.initials: S
authors.lastname: Boase
authors.forename: Josh
authors.initials: J
authors.lastname: Jervis-Bardy
authors.forename: Jay-Dee
authors.initials: JD
authors.lastname: Dones Cabral
authors.forename: Simon
authors.initials: S
authors.lastname: Robinson
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D020212:Carotid Artery Injuries / Q000628:therapy*; D002343:Carotid Artery, Internal; D048271:Chitosan / Q000627:therapeutic use; D004724:Endoscopy / Q000009:adverse effects*; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D005782:Gels; D006488:Hemostasis, Surgical / Q000379:methods; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D007431:Intraoperative Complications / Q000628:therapy; D008953:Models, Anatomic; D011897:Random Allocation; D034561:Sheep, Domestic; D013525:Surgical Instruments
chemical_list: C411004:FloSeal Matrix; D005782:Gels; D006490:Hemostatics; D048271:Chitosan