A comparison of isobutyl 2-cyanoacrylate glue, fibrin adhesive, and oxidized regenerated cellulose for control of needle hole bleeding from polytetrafluoroethylene vascular prostheses

Abstract

Prolonged anastomotic and needle hole bleeding from synthetic vascular prostheses is a common surgical problem in heparinized patients and in the patient with a coagulopathy. The relative effectiveness of various hemostatic agents has not previously been determined by controlled comparisons. In this study 6 mm polytetrafluoroethylene (PTFE) vascular prostheses were used to perform carotid-carotid and femorofemoral bypasses in eight heparinized dogs. The relative effectiveness of isobutyl 2-cyanoacrylate, fibrin adhesive, and oxidized regenerated cellulose was determined by application of these hemostatic agents to three sources of bleeding: arterial-PTFE anastomoses, PTFE-PTFE anastomoses, and 18-gauge needle holes in PTFE vascular prostheses. The mean time to hemostasis (MTH) was determined for each hemostatic agent. Although application of isobutyl 2-cyanoacrylate resulted in the shortest MTH in each experimental group, the reported inflammatory response that it induces and its possible carcinogenicity limits its availability for clinical use. Application of fibrin adhesive prepared from single-donor hepatitis-screened plasma resulted in a significantly shorter MTH in each experimental group when compared with oxidized regenerated cellulose. We recommend clinical use of fibrin adhesive to control needle hole and anastomotic bleeding from PTFE vascular prostheses.

A Polymeric Sealant Inhibits Anastomotic Suture Hole Bleeding More Rapidly Than Gelfoam/Thrombin<subtitle>Results of a Randomized Controlled Trial</subtitle>

“…19,24,26,29 This explains, in large part, the differences observed between treatment groups in the immediate and early sealing rates. On application, CoSeal forms a cohesive anastomotic seal within seconds that adheres strongly to the applied tissue site, effectively providing a mechanical barrier to blood flow without the need to induce coagulation.…”

Effectiveness of cyanoacrylate adhesive in rabbit aortorrhaphy

“…2 Cyanoacrylate glue has exhibited high effectiveness, quick fixation and strong enough tensile force to maintain tissues closed. 1,[6][7][8] Cyanoacrylate has also exhibited greater strength than fibrin glue for maintaining tissues together 5 and for controlling bleeding from needle holes. 2,4 This adhesive has the advantage of not being dependent on the patient's coagulation status and it can also be used in cases in which coagulopathies are present.…”

“…It is also possible, however, that the thrombus could be due to the low heparin doses used in this study (100 mg/kg). Heparin dosages vary between different studies, with Saba et al, 1 for instance, using 100 mg/kg and Barbalinardo et al 8 using double this dose.…”

A Sheep Model for Thoracic Aortic Surgery in the Presence of Systemic Coagulopathy

“…Citrin et al developed a coagulopathic model in mongrel dogs using iv heparin (100 U/kg) given at the start of surgery, which was followed by repeated doses of iv heparin (50 U/kg) during surgery to establish bleeding from needle holes from polytetra ouroethylene (PTFE) grafts anastomosed to femoral arteries [6]. Similarly, Barbalinardo et al administered iv heparin (200 U/kg) initially, followed by repeated doses of iv heparin (50 U/kg) at the end of each hour in experimental bypass surgery using PTFE grafts anastomosed femoro-femoral and carotid-carotid [7]. Aspirin was not administered and the extent of coagulation defects was not determined in these studies.…”