Biodegradation and Immunological Parameters of Polyurethane‐Based Tissue Adhesive in Arterial Microvascular Anastomoses—A Long‐Term In Vivo Study

Abstract

In microsurgical anastomosis, non‐synthetic fibrin‐based adhesives have predominantly shown superior properties to synthetic cyanoacrylates, but they have hardly any clinical application. This study aims to investigate the local and systemic effects of synthetically produced biodegradable adhesive VIVO when used in microsurgical anastomosis. VIVO is used in two different anastomosis procedures in the common carotid artery in a rat model: VIVO in addition to a temporary catheter (VIVO TC) and VIVO with a custom‐shaped memory nitinol stent (VIVO SM). Conventionally sutured anastomoses serve as controls (C). Tissue response is assessed by in vivo fluorescence imaging and histological examination. The systemic effects of biodegradation are measured using hematologic parameters and serum levels of transaminase activity and lactate dehydrogenase. Finally, the degree of local adhesion of the different anastomotic procedures is evaluated. Fluorescence imaging shows reduced inflammatory blood flow in the VIVO TC group. Histological analysis of the anastomosed vessels also reveals significantly more inflammation in C than in the two adhesive groups. The severity of VIVO adhesions proves acceptable, and no histotoxic effects of VIVO are detected. The data demonstrate that the synthetic tissue adhesive VIVO is a reliable and—compared to sutures—tissue‐friendly adhesive for microsurgical anastomoses.

Evaluation of the Hemostatic Effect of an Innovative Tissue Adhesive during Extraction Therapy under Rivaroxaban in a Rodent Model

“…Nevertheless, a major disadvantage of collagen sponges is that they are made of animal native type I and type III collagens [46], and these, like any xenogeneic preparation, pose an increased risk of allergic, immunologic, and even anaphylactic reactions [47]. In rat studies, VIVO showed sufficient hemostasis under moist conditions when applied in a sealing fashion to vascular anastomoses [20,24]. In the histologic evaluation, VIVO showed comparable thrombus formations when compared to extraction sockets treated with GSP.…”

“…The novel polyurethane-based tissue adhesive VIVO (Adhesys Medical GmbH, Aachen, Germany) is an innovative biodegradable adhesive that has demonstrated rapid and safe application [20]. It is an alternative to conventional hemostasis [21][22][23] with favorable tissue compatibility [24], as evidenced by good biocompatibility during the various degradation phases [23]. The authors hypothesized that the use of polyurethane-based VIVO leads to a decrease in postoperative bleeding under good wound healing conditions after dental removal under rivaroxaban therapy.…”

Sutureless vascular anastomotic approaches and their potential impacts

“…Polyethylene glycol (PEG) hydrogels, represented by FocalSeal and TissuGlu, boast adaptability and biocompatibility, making them valuable for the dynamic realm of vascular anastomosis [ 104 , 105 ]. Polyurethane-based adhesives add another dimension of choice in the anastomosis toolkit [ [106] , [107] , [108] ]. Furthermore, polysaccharide-based adhesives, derived from natural sugars, guarantee both biodegradability and biocompatibility, ensuring effective vascular seals with minimized inflammation [ [109] , [110] , [111] ].…”

“…A novel biodegradable polyurethane-based adhesive, VIVO, was introduced as an additional safety measure in surgical procedures [ [106] , [107] , [108] ]. Comprising an isocyanate-functionalized prepolymer and an amino-based curing agent, VIVO exhibited impressive adhesive strength on wet tissues.…”

“…Polyurethane-based adhesive and cyanoacrylate proved significantly faster and more stable than fibrin glue, with both withstanding higher pressures and tensile forces. However, before clinical application of VIVO, further research is needed to optimize its properties for sutureless arterial anastomoses, understand its long-term degradation, and assess its overall safety and effectiveness, particularly in relation to vessel wall stability post-degradation [ 108 , 118 , 119 ].

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