title: Meta-analysis of the use of surgical sealants for suture-hole bleeding in arterial anastomoses.
abstract: BACKGROUND
  Suture-hole bleeding in arterial anastomoses prolongs operating time and increases blood loss, particularly with the use of prosthetic grafts. Surgical sealants (such as fibrin) may be used as haemostatic adjuncts in vascular surgery. This is a systematic review and meta-analysis of published studies that investigated the utility of surgical sealants in arterial-to-prosthetic graft anastomoses.
  
  
  METHODS
  A systematic review was undertaken of papers published until January 2015 on Embase, MEDLINE, PubMed, PubMed Central and Cochrane databases that analysed the use of surgical sealants as haemostatic adjuncts after arterial anastomoses. RCTs were included, with study endpoints of time to haemostasis or haemostasis at 5 min. Secondary outcomes included treatment failure, mean difference in estimated blood loss and duration of surgery. Sensitivity and subgroup analyses were performed, as well as funnel plot analysis for publication bias.
  
  
  RESULTS
  A total of 2513 citations were reviewed; 19 RCTs comprising 1560 patients were ultimately included in the analysis. The majority of studies compared fibrin sealant with control haemostatic measures. Pooled analysis suggested that surgical sealants reduced the time to haemostasis (mean difference 243·26 (95 per cent c.i. 183·99 to 302·53) s; P < 0·001), improved haemostasis at 5 min (odds ratio 4·50, 95 per cent c.i. 2·59 to 7·81; P < 0·001), and were associated with less treatment failure, blood loss and shorter duration of surgery.
  
  
  CONCLUSIONS
  Surgical sealants appear to reduce suture-hole bleeding significantly in vascular prosthetic graft anastomoses compared with standard haemostatic measures.
authors.affiliation: Department of Vascular Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: A C
authors.identifier: http://orcid.org/0000-0001-6215-5487
authors.initials: AC
authors.lastname: Rogers
authors.affiliation: Department of Vascular Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: L P
authors.initials: LP
authors.lastname: Turley
authors.affiliation: Department of Vascular Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: K S
authors.initials: KS
authors.lastname: Cross
authors.affiliation: Department of Vascular Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: M P
authors.initials: MP
authors.lastname: McMonagle
mesh_terms: D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006488:Hemostasis, Surgical; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D013537:Sutures / Q000009:adverse effects*; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D006490:Hemostatics; D014014:Tissue Adhesives