Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model

Bijan S. Kheirabadi, Aida Field-Ridley, Rebecca Pearson, Martin MacPhee, William Drohan, David Tuthill

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective. The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures. Methods. End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone ("untreated") or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed. Results. Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 ± 19.2 (mean ± SD) ml blood loss and 100% mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 ± 17.6, Avitene 80.6 ± 34, Surgicel 66.7 ± 16.7, FloSeal 44.2 ± 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 ± 21.8 ml blood loss and 100% survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 ± 10, Avitene 50.9 ± 12.4, Surgicel 32.1 ± 14, FloSeal 33.9 ± 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 ± 19 and 21.3 ± 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively). Conclusion. In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures.

Original languageEnglish (US)
Pages (from-to)99-107
Number of pages9
JournalJournal of Surgical Research
Volume106
Issue number1
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Fibrin Tissue Adhesive
Hemostatics
Sutures
Rabbits
Hemostasis
Absorbable Gelatin Sponge
Collagen
Hemorrhage
Aorta
Tissue Adhesives
Exsanguination
Suture Techniques
Abdominal Aorta
Constriction
Blood Vessels
Research Personnel
Mortality

Keywords

  • Anastomosis
  • Animal model
  • Avitene
  • Control
  • Fibrin sealant
  • FloSeal
  • Gelfoam
  • Hemorrhage
  • Hemostasis
  • Surgicel
  • Vascular

ASJC Scopus subject areas

  • Surgery

Cite this

Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model. / Kheirabadi, Bijan S.; Field-Ridley, Aida; Pearson, Rebecca; MacPhee, Martin; Drohan, William; Tuthill, David.

In: Journal of Surgical Research, Vol. 106, No. 1, 2002, p. 99-107.

Research output: Contribution to journalArticle

Kheirabadi, Bijan S. ; Field-Ridley, Aida ; Pearson, Rebecca ; MacPhee, Martin ; Drohan, William ; Tuthill, David. / Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model. In: Journal of Surgical Research. 2002 ; Vol. 106, No. 1. pp. 99-107.
@article{d9b8d9027a174e9495c80e458e6916f9,
title = "Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model",
abstract = "Objective. The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures. Methods. End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone ({"}untreated{"}) or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed. Results. Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 ± 19.2 (mean ± SD) ml blood loss and 100{\%} mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 ± 17.6, Avitene 80.6 ± 34, Surgicel 66.7 ± 16.7, FloSeal 44.2 ± 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 ± 21.8 ml blood loss and 100{\%} survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 ± 10, Avitene 50.9 ± 12.4, Surgicel 32.1 ± 14, FloSeal 33.9 ± 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 ± 19 and 21.3 ± 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively). Conclusion. In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures.",
keywords = "Anastomosis, Animal model, Avitene, Control, Fibrin sealant, FloSeal, Gelfoam, Hemorrhage, Hemostasis, Surgicel, Vascular",
author = "Kheirabadi, {Bijan S.} and Aida Field-Ridley and Rebecca Pearson and Martin MacPhee and William Drohan and David Tuthill",
year = "2002",
doi = "10.1006/jsre.2002.6426",
language = "English (US)",
volume = "106",
pages = "99--107",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model

AU - Kheirabadi, Bijan S.

AU - Field-Ridley, Aida

AU - Pearson, Rebecca

AU - MacPhee, Martin

AU - Drohan, William

AU - Tuthill, David

PY - 2002

Y1 - 2002

N2 - Objective. The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures. Methods. End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone ("untreated") or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed. Results. Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 ± 19.2 (mean ± SD) ml blood loss and 100% mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 ± 17.6, Avitene 80.6 ± 34, Surgicel 66.7 ± 16.7, FloSeal 44.2 ± 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 ± 21.8 ml blood loss and 100% survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 ± 10, Avitene 50.9 ± 12.4, Surgicel 32.1 ± 14, FloSeal 33.9 ± 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 ± 19 and 21.3 ± 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively). Conclusion. In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures.

AB - Objective. The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures. Methods. End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone ("untreated") or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed. Results. Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 ± 19.2 (mean ± SD) ml blood loss and 100% mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 ± 17.6, Avitene 80.6 ± 34, Surgicel 66.7 ± 16.7, FloSeal 44.2 ± 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 ± 21.8 ml blood loss and 100% survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 ± 10, Avitene 50.9 ± 12.4, Surgicel 32.1 ± 14, FloSeal 33.9 ± 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 ± 19 and 21.3 ± 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively). Conclusion. In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures.

KW - Anastomosis

KW - Animal model

KW - Avitene

KW - Control

KW - Fibrin sealant

KW - FloSeal

KW - Gelfoam

KW - Hemorrhage

KW - Hemostasis

KW - Surgicel

KW - Vascular

UR - http://www.scopus.com/inward/record.url?scp=0036377248&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036377248&partnerID=8YFLogxK

U2 - 10.1006/jsre.2002.6426

DO - 10.1006/jsre.2002.6426

M3 - Article

VL - 106

SP - 99

EP - 107

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -