Systematic review of hemostatic agents used in vascular surgery

Allotey, Jonathan K.; King, Alexander H.; Kumins, Norman H.; Wong, Virginia L.; Harth, Karem C.; Cho, Jae S.; Kashyap, Vikram S.

doi:10.1016/j.jvs.2020.10.081

Cited by 19 publications

(15 citation statements)

References 32 publications

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“…Such materials are also willingly used in patients suffering from various hemostatic abnormalities. HemA minimizes the risk of peri-operative bleeding, decreases surgery duration, and provides support for the veins and arteries [ 1 , 2 , 3 ]. Importantly, hemostatic agents can be used not only by medics but also by individuals or military.…”

Section: Introductionmentioning

confidence: 99%

“…Other examples include HemA based on bone wax. The second group comprises biodegradable materials, which are mostly prepared from various natural polymers such as microfibrillar collagen, gelatin, oxidized regenerated cellulose, polysaccharidic microspheres, and others [ 1 , 4 , 5 , 6 , 7 , 8 ]. These are mainly applied in the form of a dry matrix with a porous structure.…”

Section: Introductionmentioning

confidence: 99%

“…When choosing appropriate HemA, one must take under consideration the mode of action (biologically passive or active), form (powder, glue, patch), and possible side effects including allergic reactions coming from animal-derived substrates, embolism, hypotension, bloodborne disease, infection, immune-mediated coagulopathy, vascular thrombosis, anaphylaxis, and others. Since all of the aforementioned biomaterials used for hemostasis restoration have some downfalls or limitations in the scope of their application, there is still a great need for novel hemostatic agents’ development characterized with improved both physicochemical and biological properties [ 1 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Fungal Chitosan-Derived Biomaterials Modified with Kalanchoe pinnata as Potential Hemostatic Agents—Development and Characterization

et al. 2021

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Massive blood loss is still a great challenge for modern medicine. To stop the hemorrhage during the surgery or after injury apart from suturing or electrocoagulation, the most efficient method of hemostasis restoration is the use of hemostatic agents. Although there are numerous products on the market, there is still a need for biomaterials that are capable of fast and efficient bleeding management without affecting wound closure or embolism. Chitosan is known for its hemostatic activity; however, its quite poor mechanical properties and heterogenous chemical composition still needs some improvements to become superior compared to biological adhesives. The following study deals with the preparation and evaluation of chitosan-derived natural biomaterials containing Kalanchoe pinnata extract with the potential application as a blood-clotting agent. The materials were obtained under microwave-assisted conditions in two different forms (granules/dressing), whose chemical structure and morphology were studied. Their antioxidant properties have been proven. The chitosan-derived hemostatic agents exhibited superior blood sorption abilities and lack of cytotoxicity to L929 mouse fibroblasts. The study also showed the differences in biological properties depending on their preparation method. The potential mechanism of action was proposed as well as their potential in hemostasis revival.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fungal Chitosan-Derived Biomaterials Modified with Kalanchoe pinnata as Potential Hemostatic Agents—Development and Characterization

et al. 2021

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“…Therefore, BioGlue is not recommended in pediatric surgery, and caution must be taken in the application on aortic suture line. Disfunction of valve prosthesis has been also reported after application [ 63 , 64 ]. There have been reports regarding the potentially harmful effects of BioGlue to local tissues [ 65 ].…”

Section: Current Haemostatic Agents and Their Clinical Use In Cardiov...mentioning

confidence: 99%

Biomaterials as Haemostatic Agents in Cardiovascular Surgery: Review of Current Situation and Future Trends

et al. 2022

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Intraoperative haemostasis is of paramount importance in the practice of cardiovascular surgery. Over the past 70 years, topical haemostatic methods have advanced significantly and today we deal with various haemostatic agents with different properties and different mechanisms of action. The particularity of coagulation mechanisms after extracorporeal circulation, has encouraged the introduction of new types of topic agents to achieve haemostasis, where conventional methods prove their limits. These products have an important role in cardiac, as well as in vascular, surgery, mainly in major vascular procedures, like aortic dissections and aortic aneurysms. This article presents those agents used for topical application and the mechanism of haemostasis and offers general recommendations for their use in the operating room.

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“…In aortic dissection repair, it is vital to ensure good sealing around the anastomotic suture line and uniform reapproximation of the dissected aortic layers to avoid problematic postoperative bleeding and minimize the need for late reintervention ( 1 ). With the development of surgical adhesives or sealants, it has become a common practice in many centers to seal the anastomotic suture lines with a surgical adhesive ( 2 , 3 ). In 2001, bovine serum albumin-glutaraldehyde (BSAG, BioGlue®, Artivion, Kennesaw, GA) was approved by FDA in 2001 to improve hemostasis of suture lines and reinforce the fragile aortic tissue during acute dissection repair ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

BioGlue® is not associated with polypropylene suture breakage after aortic surgery

Pacini

Murana

Hollinworth³

et al. 2022

Front. Surg.

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ObjectiveWe have encountered broken or damaged polypropylene sutures (Prolene®) at the anastomotic sites during aortic reoperations. Because a surgical sealant, bovine serum albumin-glutaraldehyde (BioGlue®), was used in previous aortic surgery in some of these cases, we undertook this in vitro study to evaluate whether the use of BioGlue® was associated with breakage of polypropylene sutures at the aortic anastomosis.Materials and methodsThe broken polypropylene sutures, anastomotic sites and aortic tissue at the location of suture breakage were visually inspected and evaluated intraoperatively. Six human cadaveric aortic samples were incised circumferentially and anastomosed proximally to a valved conduit with running 4–0 polypropylene sutures (Prolene®). In the test group (n = 3), BioGlue® was applied directly to the Prolene® sutures at the anastomotic sites, while in the control group (n = 3) the anastomoses were not sealed with any surgical adhesive. The six samples were immersed in Dulbecco's phosphate buffered saline solution and mounted on a M-6 Six Position Heart Valve Durability Testing System and tested up to 120 million cycles for a 2-year period. During and upon completion of the testing, the integrity of Prolene® sutures, the anastomosis and aortic tissues was regularly assessed by visual inspection.ResultsIntraoperative findings included a stretched and thin aortic wall (some with thrombus), a small cleft between the aortic tissue and the Dacron vascular graft. An excessive amount of BioGlue® was often found around the anastomosis, with cracking material, but no signs of mechanical damage were observed in these cases. Upon visual inspection during and after in vitro testing, there was no apparent damage to the polypropylene sutures on the interior or exterior of the aortic anastomoses in any of the samples. No difference was observed in the physical integrity of the polypropylene sutures at anastomotic lines, the anastomoses and aortic tissues between the test and control samples.ConclusionsThe results of this study suggest that the use of BioGlue® was not associated with breakage of the polypropylene sutures at the anastomotic sites after aortic dissection repair.

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Systematic review of hemostatic agents used in vascular surgery

Cited by 19 publications

References 32 publications

Fungal Chitosan-Derived Biomaterials Modified with Kalanchoe pinnata as Potential Hemostatic Agents—Development and Characterization

Fungal Chitosan-Derived Biomaterials Modified with Kalanchoe pinnata as Potential Hemostatic Agents—Development and Characterization

Biomaterials as Haemostatic Agents in Cardiovascular Surgery: Review of Current Situation and Future Trends

BioGlue® is not associated with polypropylene suture breakage after aortic surgery

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