Abstract
PurposeThe aim of this study is evaluate the efficacy of TachoSil® patches in controlling suture-hole bleeding after elective infrarenal abdominal aortic aneurysm (AAA) replacement with Dacron graft.Materials and methodsPatients undergoing elective replacement of infrarenal AAA with Dacron grafts were prospectively randomized to TachoSil® patches (Group I) or standard compression with surgical swabs (Group II).We evaluated time to haemostasis, blood loss during the operation, blood loss after cross-clamp removal, duration of operation, drain volume, requirement for blood transfusion and surgeons rating of efficacy.ResultsTwenty patients were randomized (10 patients in each treatment Group). The mean time to haemostasis was 264 ± 127.1 s (range: 180-600 s) in Group I and 408 ± 159.5 s (range: 120-720 s) in Group II (p = 0.026); mean blood loss during the operation was 503.5 ± 20.7 cc (range: 474-545 cc) in Group I and 615.7 ± 60.3 cc (range: 530-720 cc) in Group II (p < 0.001); mean blood loss after cross-clamp removal was 26.5 ± 4 g (range: 22-34 g) in Group I and 45.4 ± 4.6 (range: 38-52 g) in Group II (p < 0.001) and mean drain volume was 116.7 ± 41.4 cc (range: 79-230 cc) in Group I and 134.5 ± 42.8 cc (range: 101-250 cc) in Group II (p = 0.034). There were no serious adverse events associated with use of TachoSil® patches.ConclusionFor patients undergoing aortic reconstruction with Dacron grafts, TachoSil® patches were found to be safe and effective for the control of suture-hole bleeding.
Highlights
Suture-hole bleeding, during aortic surgery, represents a risk for the patient in terms of blood loss and prolongation of operation due to additional suturing with danger of iatrogenic stenosis
Haemostasis was achieved within 5 min in 90% of the patients in Group I compared to only 70% within 7 min in Group II
Despite the small number of patients enrolled, the present study showed that TachoSil® significantly reduces the time to haemostasis
Summary
Suture-hole bleeding, during aortic surgery, represents a risk for the patient in terms of blood loss and prolongation of operation due to additional suturing with danger of iatrogenic stenosis. This complication is more relevant in the use of expanded polytetrafluoroethylene, it may occur after Dacron graft replacement [1,2]. TachoSil® is indicated in adults for supportive treatment in surgery for improvement of haemostasis, to promote tissue sealing, and for suture support in vascular surgery where standard techniques are insufficient [4] It is a ready-to-use and absorbable haemostatic dressing. The aim of the study was to compare the efficacy and safety of TachoSil® patches against standard surgical compression to control the suture-hole bleeding from Dacron grafts in aortic surgery
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