The threat of adhesive embolization: BioGlue leaks through needle holes in aortic tissue and prosthetic grafts
The threat of adhesive embolization: BioGlue leaks through needle holes in aortic tissue and prosthetic grafts
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DOI：
10.1016/j.athoracsur.2005.02.004
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发表时间：
2005-07-01
影响因子：
4.6
通讯作者：
Coselli, JS
中科院分区：
文献类型：
--
作者：
LeMaire, SA;Carter, SA;Coselli, JS
背景资料。BioGlue外科粘合剂(CryoLife，Inc.，Kennesaw，GA)用于在心血管手术中加强吻合口。以前的报道已经提出了一些担忧，即粘合剂可能会通过缝合线针孔渗漏，而由此产生的管腔内胶可能会发生栓塞。本研究的目的是确定生物胶是否通过主动脉组织和两种常见的假体移植材料的吻合针孔渗漏。用聚丙烯缝线在明胶密封的编织聚酯移植物(n=45)、膨体聚四氟乙烯(EPTFE)移植物(n=45)和新鲜猪主动脉(n=45)上建立端到端吻合。在ePTFE移植物中使用ePTFE缝线建立了另外45个吻合口。每个吻合口的外表面都覆盖有生物胶。对吻合口进行直接放大或组织学检查。在10%的吻合口(18/180)，生物胶从针孔渗漏到管腔。新鲜主动脉的渗漏(10/45，22%)明显多于人工血管(8/135，6%；p=0.003)。缝线大小对渗漏发生率无显著影响。使用ePTFE缝线并不能消除BioGlue的渗漏。假体移植物的泄漏产生了谨慎的圆形粘合剂颗粒。相比之下，主动脉组织渗漏导致沿内膜表面延伸的薄薄、易碎的胶片。主动脉组织学证实生物胶通过缝合通道到达管腔。生物胶从新鲜的主动脉组织和人工血管的针孔中渗漏出来。腔内粘连颗粒很容易移位，这支持了对栓塞术的担忧。在考虑使用BioGlue的相对风险和益处时，粘附性栓塞术的可能性应该是一个因素。(C)2005年，由胸外科医生学会提供。
Background. BioGlue Surgical Adhesive (CryoLife, Inc, Kennesaw, GA) is used to reinforce anastomoses during cardiovascular operations. Previous reports have raised concerns that adhesives may leak through suture-line needle holes and that resulting intraluminal glue may embolize. The purpose of this study was to determine if BioGlue leaks through anastomotic needle holes in aortic tissue and two common prosthetic graft materials.Methods. Polypropylene suture was used to create end-to-end anastomoses in gelatin-sealed woven polyester grafts (n = 45), expanded polytetrafluoroethylene (ePTFE) grafts (n = 45), and fresh porcine aortas (n = 45). An additional 45 anastomoses were created in ePTFE grafts using ePTFE sutures. The outer surface of each anastomosis was covered with BioGlue. Anastomoses underwent inspection with direct magnification or histology.Results. BioGlue leaked through needle holes and into the lumen in 10% of anastomoses (18 of 180). Leaks were significantly more common in fresh aorta (10 of 45, 22%) than in prosthetic grafts (8 of 135, 6%; p = 0.003). Suture size did not significantly affect the incidence of leak. The use of ePTFE sutures did not eliminate BioGlue leakage. Prosthetic graft leaks created discreet round adhesive particles. In contrast, aortic tissue leaks resulted in thin, friable flakes of glue extending along the intimal surface. Aortic histology confirmed that BioGlue reached the vessel lumen via the suture channels.Conclusions. BioGlue leaked through the needle holes in fresh aortic tissue and prosthetic grafts. Intraluminal adhesive particles were easily dislodged, supporting concerns regarding embolization. The potential for adhesive embolization should be a factor when considering the relative risks and benefits of using BioGlue. (c) 2005 by The Society of Thoracic Surgeons.