Evaluation of the long‐term results of vascular anastomosis using polyurethane adhesive and shape‐memory stent in the rat carotid artery model

Abstract

Introduction:In free flaps, 5%-10% of complications are related to failure of sutured vascular anastomoses. Adhesive-based microvascular anastomoses are potential alternatives but are associated with failure rates of 70% in research studies. VIVO is a new adhesive with slow biodegradation within 6 months that has shown a 100% patency rate in research studies over 2 h observation time but long-term patency has not been evaluated. The authors hypothesize that VIVO will enable a reliable microvascular procedure comparable to sutured anastomoses over a 28-day period. Materials and Methods:The right common carotid artery of 60 male Sprague Dawley rats, $450 g, were used for microvascular end-to-end anastomosis. VIVO was applied with reduced sutures with a temporary catheter in one group and in the other with a custom-shaped memory stent. Anastomoses with eight interrupted sutures served as control. All groups were n = 20. Anastomosis time and bleeding were recorded for each procedure. Doppler flowmetry was performed 20 min, 1, 10, and 28 days postoperatively. Postmortem toluidine staining was used for semi-quantitative analysis of stenosis, thrombosis, necrosis, and aneurysm formation by histologic evaluation. Results:No occlusion was detected 20 min and 1 day postoperative, and after 28 days of observation in all anastomoses. The anastomosis time of the VIVO with catheter group was about 32% significantly faster than the VIVO with stent group. In the VIVO group with stent, the bleeding time was $80% shorter than in the control group with 2.1 ± 0.3 and VIVO with catheter 2.0 ± 0.5 (p ≤ .001 each). Minor and nonsignificant stent-associated thrombus formation and stent-typical intraluminal stenosis were detected exclusively in the VIVO with stent group. Conclusion:Within the limitations of a rat study, the use of VIVO in anastomosis showed promising results. VIVO with catheter was found to be advantageous.

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].…”

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.…”

“…The catheter method using VIVO was 32 % faster in anastomosis time and had a similar reduction in bleeding time as the stent method when compared to the control. However, the stent method showed minor stenosis and thrombus formation related to the stent [ 43 , 106 ]. In an ex vivo study using chicken femoral arteries, a new polyurethane-based adhesive was compared with fibrin glue and cyanoacrylate for sutureless microsurgical anastomosis.…”