A Polymeric Sealant Inhibits Anastomotic Suture Hole Bleeding More Rapidly Than Gelfoam/ThrombinResults of a Randomized Controlled Trial

Abstract

PROSTHETIC VASCULAR grafts, primarily those composed of polytetrafluoroethylene (PTFE), have undergone several decades of extensive clinical evaluation.^1-5 For selected clinical indications, such as an above-knee femoropopliteal bypass, PTFE grafts offer clinical results that approach the performance normally achieved with autologous vascular grafts.^6-9 It has been argued that early use of prosthetic grafts preserves autologous vessels for future use.^10,11 In other cases, native vessels may become unsalvageable for vascular reconstruction, as in patients on hemodialysis who require sustained access shunting.^12-18 While long-term clinical performance of PTFE grafts may be satisfactory, surgical implantation is not without disadvantages. Vascular surgeons tacitly recognize, and some research provides empirical support, that anastomotic suture hole bleeding with PTFE grafts is more frequent, more copious, and of longer duration than with autologous grafting.^19-22 Troublesome anastomotic bleeding may require protracted manual compression with gauze and sponges before surgical wound closure can be performed.