Background. Suture hole bleeding is a frequent complication in vascular sur
gery. The use of fibrin sealants (FSs) during surgery is reported to reduce
blood loss by enhancing hemostasis.
Objectives. Using a pig vascular graft model we investigated: (1) the use o
f FSs in vascular surgery and measured blood loss with and without the use
of FSs; (2) the effect of factor XIII in FSs on hemostasis and blood loss;
and (3) the effect of increasing FS incubation time on hemostasis and blood
loss.
Materials and methods. During surgery, a 3-cm incision was made in the caro
tid artery wall. Incisions were covered with a Gore-Tex (PTFE) patch suture
d with Ethicon monofil 5/0 or 3/0. The resulting suture holes were treated
according to study protocol. Study 1: Nine pigs received either FS treatmen
t (n = 5) or no treatment (n = 4). Study 2: Twenty pigs underwent bilateral
surgery; right (n = 20) and left (n = 20) patches received either FS with
factor XIII (FS + FXIII) or FS depleted of factor XIII (FS - FXIII). Study
3: Bilateral surgery was carried out on 24 pigs; PFTE patches secured with
Ethicon 3/0 were treated with FS and allowed to polymerize for 120 s (n = 1
2), 180 s (n = 12), or 240 s (n = 12) or with solid support/thrombin (n = 1
2).
Results. Study 1: Mean. blood loss was significantly lower in the FS-treate
d group compared with untreated controls (9.2 +/- 10.6 mL vs 178.8 +/- 125.
5 mt, mean +/- SD, P = 0.016). Study 2: Significantly less blood was lost i
n the FS + FXIII group than in the FS - FXIII group (Delta = 9.6 mL, P = 0.
02). Study 3: Blood loss was significantly higher from patches treated with
solid support/thrombin compared with those treated with FS (P < 0.01).
Conclusions. FSs containing factor XIII, such as Beriplast P, are effective
in reducing suture hole bleeding and improving hemostasis during vascular
graft procedures. The presence of factor XIII contributes to the efficacy o
f FSs and reduces the time to hemostasis. During vascular surgery, blood lo
ss can be reduced significantly by the use of fibrin sealant compared with
absorbable gelatin sponges coated with thrombin. (C) 2000 Academic Press.