Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy

Abstract

Biologic patches that undergo active remodeling in the carotid artery require greater thickness than was anticipated to decrease wall stress and suture hole elongation. Patches exceeding this minimum thickness will be required to ensure the safety of new SIS patch designs for vascular operations.

Editorial Comment: Do not throw away anything from the pig

“…The same encouraging results were not obtained in the clinical experience by McCready, who reported seven episodes of patch aneurysm among 76 patients who had undergone patch angioplasty of the carotid artery following endoarterectomy [3]. The patch used in this latter study was another SIS-ECM product (Surgisis ® by Cook Surgical, Bloomington, IN, USA) that was thinner than CorMatrix.…”

Adverse effects of porcine small intestine submucosa implants in experimental ventral hernia repair

“…We think that a closed environment around the defect site was created and inflammatory cells were trapped, leading to a consistent histological picture [1]. Other recent human and experimental studies have reported similar effects of SIS [5,13]. Helton et al [5] investigated the potential role of SIS in open and laparoscopic repair of incisional hernia.…”

“…The authors reported mesh infection (reaction) in four of 22 patients from the best (=clean) wound group and an overall recurrence rate of 17% within a 14-month median observation period. Furthermore, rapid shrinking of SIS (>40% in 8 weeks) was described by Poulose et al [20] and might also have played a role in the SIS-related formation of pseudoaneurysm in carotid endarterectomy described by McCready et al [13]. It is obvious that the questions arising from these observations have to be fully elucidated prior to routine clinical use of SIS in hernia repair.…”

Interventional Atrial Septal Defect Closure Using a Totally Bioresorbable Occluder Matrix

“…It is gradually resorbed by the host organism and subsequently replaced by host tissue (12,17). Following extensive experimental investigations, porcine small intestinal submucosa has been successfully used clinically in various fields of soft tissue augmentation, to treat hernias and in tendon repair (18 -20), stress urinary incontinence (21), leg ulcers (22), plastic surgery (23), and vascular surgery (24).…”