Evaluación in vitro de los dispositivos de energía para el sellado de colaterales de vena safena en cirugía de revascularización

Espínola, Moisés Falcón; García, Lucia; Andani, Emma Plana; Nevárez, Manuel Ignacio Sánchez; Ferrer, Nohelia Rojas; Hernández, Manuel Miralles

doi:10.20960/angiologia.00016

Cited by 2 publications

(4 citation statements)

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“…En un estudio previo realizado por nuestro grupo se demostró la no inferioridad de estos sistemas de sellado con respecto a la ligadura convencional, en colaterales venosas sometidas a presiones arteriales y con presiones de estallido suprafisiológico en un circuito hemodinámico in vitro (17).…”

Section: Discussionunclassified

“…La presión de estallido se registró para ambos dispositivos y se obtuvieron presiones suprafisiológicas (788,9 ± 455 mmHg para EB y 602,5 ± 363,1 mmHg para BA) sin obtener diferencias estadísticamente significativas entre ellos, aunque sí se observaron diferencias en el lugar donde se localizaba la zona de fuga. Los injertos sellados con EB fueron más resistentes (17).…”

Section: Introductionunclassified

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Animal model for assessing collateral vein sealing with energy-based devices in revascularization surgery

Espínola¹,

Andani²,

Velasco³

et al. 2023

Angiologia

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Introduction: energy sealing devices achieve hemostasis of the vessels through the heat generated and coagulation of the vascular wall's proteins. However, mid-term efficacy for venous graft sealing in arterial bypass surgery, remains unknown Objectives: to create an animal model which allows the comparison of mid-term efficacy and safety at the sealing zone after the healing process. To compare and assess which in vivo arterial models show lower morbidity and higher survival after 4 weeks postoperative. Material and methods: an in vivo experimental study of 16 New Zealand rabbits. In each rabbit a human saphenous vein (SV) with at least one venous collateral was implanted. Two arterial models were developed: infrarrenal aorta bypass with SV (n = 5) and aortoplasty with SV patch (n = 11). In both models the collateral was randomized ad sealed with one energy sealing devices: Electrothermal Bipolar Vessel Sealing (EBVS) or Harmonic scalpel (HS). Every animal was treated with antithrombotic prophylaxis and immunosuppressive medication. Intraoperative mortality, paraplegia, infection, bleeding, and survival was analyzed. Results: two animals (50 %) survive at the 7th postoperative day in the bypass model, but anyone survived the four weeks postoperative in this model. In the aortoplasty group, seven-day survival was 55,56 % (5/9) and 4-weeks survival was 44,44 % (4/9) (p = 0.05). Paraplegia rate was 100 % for the bypass model and much lower for the patch group (25 %) (p = 0,03). Mean ischemic time was lower for the aortoplasty model (37,11 ± 8,1 min) compared to bypass group (42 ± 10,61 min) (p = 0.414). No animal presented intrabdominal hemorrhage or adverse drug reaction for immunosuppressive medication. Conclusion: aortoplasty with SV patch model has shown a lower paraplegia rate and a lower mortality at 7 days in the animal model performed. Both bypass model and patch model have shown efficacy at the sealing zone but only in the aortoplasty model four animals survived after 4 weeks.

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Section: Discussionunclassified

Section: Introductionunclassified

Animal model for assessing collateral vein sealing with energy-based devices in revascularization surgery

Espínola¹,

Andani²,

Velasco³

et al. 2023

Angiologia

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“…Efficacy of energy‐based sealing systems has been studied in in vitro models [11, 13], as well as in animals [2, 4, 7] and humans [9, 14]. Indeed, EB and HS devices have proven to be a safe alternative to conventional ligature, in different surgical procedures such as pulmonary resection [3, 6, 9], laparoscopic colectomy [10], nephrectomy [15] hysterectomy [8, 16, 17], and thyroidectomy [18].…”

Section: Discussionmentioning

confidence: 99%

“…Sample size was estimated based on the results of a pilot study comparing burst pressure of ligature of collaterals (1171.6 ± 466.8 mmHg ( n = 5) and HE or EB ( n = 20) (581.4 ± 315 mmHg) [11]. Accepting an alpha risk of 0.05 and a beta risk of 0.2 in a two‐sided test, 10 subjects would be necessary in each group to recognize as statistically significant a minimum difference of 590 mmHg between any pair of groups.…”

Section: Methodsmentioning

confidence: 99%

“In Vitro” Evaluation of Energy‐Based Sealing of Graft Side Branches in Bypass Surgery

et al. 2023

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Introduction Our objective was to compare the in vitro efficacy of electrothermal bipolar [EB] vessel sealing and ultrasonic harmonic scalpel [HS] versus mechanical interruption, with conventional ties or surgical clips (SC), in sealing saphenous vein (SV) collaterals, during its eventual preparation for bypass surgery. Methods Experimental in vitro study on 30 segments of SV. Each fragment included two collaterals at least 2 mm in diameter. One of them was sealed by ligation with 3/0 silk ties (control) and the other one with EB (n = 10), HS (n = 10) or medium-6 mm SC (n = 10). After incorporation in a closed circuit with pulsatile flow, the pressure was progressively increased until causing rupture. Collateral diameter, burst pressure, leak point, and histological study were recorded. Results Burst pressure was higher for SC (1320.20 ± 373.847 mmHg) as compared with EB (942.2 ± 344.9 mmHg, p = 0.065), and especially with HS (637.00 ± 320.61 mmHg, p = 0.0001). No statistically significant difference between EB and HS was found, and bursting always happened at supraphysiological pressures. The leak point for HS was always detected in the sealing zone (10/10), while for EB and SC, it occurred in the sealing zone only in 6/10(60%) and 4/10(40%), respectively (p = 0.015). Conclusions Energy delivery devices showed similar efficacy and safety in sealing of SV side branches. Although bursting pressure was lower than with tie ligature or SC, non-inferiority efficacy was shown at the range of physiological pressures in both, EB and HS. Due to their speed and easy handling, they may be useful in the preparation of the venous graft during revascularization surgery. However, remaining questions about healing process, potential spread of tissue damage and sealing durability, will require further analysis.

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Evaluación in vitro de los dispositivos de energía para el sellado de colaterales de vena safena en cirugía de revascularización

Cited by 2 publications

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Animal model for assessing collateral vein sealing with energy-based devices in revascularization surgery

Animal model for assessing collateral vein sealing with energy-based devices in revascularization surgery

“In Vitro” Evaluation of Energy‐Based Sealing of Graft Side Branches in Bypass Surgery

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