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Notes: Background: The current use of collagen vascular hemostasis devices to percutaneously seal femoral arteriotomy sites is limited by a significant incidence of vascular complications. The purpose of the present study was to assess the efficacy of new collagen plug specifically designed to avoid these complications by accurately gauging the depth of the femoral artery and by minimizing the risk of intra-arterial collagen deployment. Methods: The hemostasis device used in this study consists of a multicomponent collagen plug with an external rigid collagen tube lined by an inner layer of absorptive sponge collagen. Placement of this plug is facilitated with a specialized two-lumen dilator, which localizes the arterial surface using a “bleedback” mechanism from one of the lumens, and prevents the placement of collagen through the arteriotomy site. The acute efficacy of this device was assessed in 26 adult dogs in which 36 collagen plugs were used to seal 8Fr femoral arteriotomies. An additional 16 arteriotomies treated with standard manual compression served as study controls. Following plug placement or manual compression, all puncture sites were observed for bleeding and hematoma formation over a 45-minute period. Patency of each instrumented artery was assessed with serial femoral angiography and localization of each plug was confirmed with surgical cutdown at the puncture site. The chronic efficacy of this device was assessed in three pigs in which three collagen plugs were used to seal 8Fr femoral arteriotomies. The three animals were subsequently sacrificed at 7,14, and 30 days, respectively, for histologic analysis. Results: In acute animals, all 36 plugs were successfully placed without evidence of vascular compromise or intra-arterial collagen deployment. In nonanticoagulated animals, hemostasis was achieved within 5 minutes in 10 of 10 plugs placed with a skin-to-arlery distance 〉 1.8 cm, in 4 of 7 plugs with a skin-to-artery distance of 1.2–1.7 cm, and in 0 of 9 plugs with a skin-to-artery distance 〈 1.2 cm. In anticoagulated animals, hemostasis within 5 minutes was demonstrated with 8 of 10 plugs with a skin-to-artery distance 〉 1.8 cm; small hematomas occurred in the remaining two animals in the setting of a PTT 〉 100 seconds. Time to hemostasis was significantly less for collagen plugs than manual compression in both nonanticoagulated animals (plug 17 ± 16 minutes; manual compression 28 ± 5 minutes; P 〈 0.03) and anticoagulated animals (plug 6 ± 2 minutes; manual compression 42 ± 4 minutes; P 〈 0.01). Chronic studies demonstrated femoral artery patency in all three pigs. Histologic analysis demonstrated progressive collagen resorption with no difference between collagen plug placement or manual compression at 30 days. Conclusions: The local hemostasis device utilized in this study resulted in accurate placement of a collagen plug immediately adjacent to the arteriotomy site with no evidence of acute or chronic vascular compromise or intra-arterial collagen deposition. Hemostasis with shorter compression times than with standard manual techniques was achieved at puncture sites in which the skin-to-artery distance was 〉 1.8 cm and the anticoagulation profile was not excessive. At 1 month postplacement, there is no histologic difference between plug use and standard manual compression. (J Interven Cardiol 1996;9:25–33)

Notes: The reliability, rapidity, and safety of nonsurgical, transatrial pericardial access for local cardiac therapy have been demonstrated in healthy animals. Since many patients take aspirin or have increased right-sided pressures, we evaluated the procedure's safety under these conditions. Transatrial pericardial access was performed in anesthetized pigs following aspirin administration (162 mg po, n = 6) or during experimental pulmonary artery hypertension (n = 4 different animals) and required only 3 minutes following guide catheter positioning. Platelet aggregability testing with arachidonic acid confirmed aspirin effectiveness. Mean pericardial fluid hematocrit was 0.1 ± 0.1% after 2 days of aspirin therapy and 1.9 ± 1.1% at sacrifice 24 hours later (NS). Mean pericardial fluid hematocrit was 1.0 ± 0.5% after 45 minutes of pulmonary artery hypertension and 4.3 ± 0.8% at sacrifice 30 minutes later (NS). Histologic analysis in both groups revealed a small thrombus and localized inflammation at the site of puncture. Neither aspirin use nor pulmonary artery hypertension causes significant bleeding into the pericardial space following transatrial access and thus does not preclude this route for local cardiac drug delivery.

Notes: A 65-year-old male presented with a descending aortic dissection. His past history was remarkable for severe blunt chest trauma 26 years prior to presentation. Operative and pathologic findings included a posttraumatic pseudoaneurysm of the thoracic aorta and an aortic dissection that originated from the orifice of the pseudoaneurysm. The ductal fovea, the mouth of the pseudoaneurysm, is an area that may be more susceptible to accelerated atherosclerosis and the complications of atherosclerosis including aortic dissection. (J Card SUrg 1994;9:65–69)

Notes: Thrombosis remains a significant and potentially catastrophic complication of polyethylene terephthalate (Dacron) prosthetic vascular graft implantation. Numerous attempts have been made to create a novel surface that reduces the adverse effects of blood interaction with the material. The purpose of this study was to create reactive groups on Dacron without significantly altering the chemical and physical properties of the biomaterial. These groups would then serve as “anchor sites” for covalent attachment of the blood protein albumin to the surface, thus creating a more biocompatible surface. Denier reduction, an established textile chemistry procedure that creates carboxyl groups on the fiber surface via hydrolysis of the material, was performed at 100°C using sodium hydroxide concentrations of 0.5, 1.0, 2.5, and 5.0% (treated materials referred to as 0.5% hydrolyzed etc.). Tensile strength determination of hydrolyzed materials revealed no statistically significant difference in material strength between control, 0.5, and 1.0% hydrolyzed materials; the 2.5 and 5.0% hydrolyzed materials had significant strength loss as compared to the controls. Significant fiber weight loss occurred in the 1.0, 2.5, and 5.0% hydrolyzed Dacron segments. The 0.5% hydrolyzed material did not have any significant weight loss. Covalent linkage of 125I-albumin to these modified materials using the crosslinker 1-ethyl-3-(3-dimethyl aminopropyl)-carbodiimide hydrochloride (EDC) resulted in the 0.5% hydrolyzed material having the greatest protein binding (330 ng/mg Dacron, 2.4-fold greater than control). Incubation of the 0.5% hydrolyzed material with EDC and various concentrations of 125I-albumin resulted in the 14.80 m̈M solution permitting the greatest binding per milligram Dacron (330 ng/mg Dacron). Scanning electron microscopy, performed blindly, revealed no change in the 0.5% hydrolyzed Dacron as compared to untreated Dacron. The 5.0% hydrolyzed Dacron, however, had noticeable structural damage on the outer periphery of the fiber surface. Observation of the untreated Dacron with nonspecifically bound albumin showed scattered areas of albumin adherent to the fiber surface whereas covalent linkage of albumin to the 0.5% hydrolyzed Dacron via EDC crosslinking showed numerous albumin moieties on each fiber. This study demonstrates that a clinically accepted biomaterial (Dacron) can be chemically modified, without significantly altering the physical and chemical characteristics of the biomaterial, in order to covalently bind albumin to the fiber surface. Thus, these results serve as foundation for creating potential novel biomaterials without significantly altering the properties of the original biomaterial. © 1995 John Wiley & Sons, Inc.

Notes: Various models have been proposed to examine blood-prosthetic materials interactions in terms of the effect of the prosthetic material on platelet structure and function, blood coagulation and fibrinolysis, and tissue infiltrates (cellular or acellular). In addition, these modeles have been used to examine the change in the graft surface over time. Particular difficulties in examining graft-materials interactions include species differences, short residence time for blood-materials interactions with commonly employed short grafts, and length of study limitations with ex vivo shunts. In this paper we report a canine, carotid-aorta subcutaneous prosthetic graft model. The specific advantages of this model are the length of the graft, which allows prolonged contact of blood with the prosthetic surface; the subcutaneous location of the graft, which allows repeated sampling of blood along the graft; and the healing characteristics of canine grafts. We selected the canine model because the healing characteristics are morphologically similar to those in humans in that endothelialization of the prosthetic surface is limited. Other models, such as the pig, are favored for use when examining blood coagulation, platelet, or fibrinolytic studies; however, these models can fully endothelialize prosthetic surfaces.

Notes: The purpose of this study was to examine the effect of the in vivo maturing ePTFE graft surface on platelet activation. Ten canines were randomized to receive either a carotid to infrarenal aorta ePTFE graft or sham operation. Animals were sampled at specific time points up to 3 months post-operatively. Whole blood platelet aggregometry (arachidonic acid, ADP, and collagen agonists) and ATP secretion (in response to arachidonic acid, ADP, collagen, and thrombin) were measured. Additionally, complete hematologic analysis and histology were performed. With time, graft animals showed significantly more decrease in platelet aggregation in response to ADP compared to sham animals (P = .023). The total amount of ATP per platelet was not different, as demonstrated by equivalent ATP release per platelet in response to thrombin. Over the first week, grafted dogs developed a decrease in systemic platelet count of 50% (P 〈 .001) that persisted over the 3-month follow-up period. With time, overall regression model slopes of graft and sham platelet count data were not statistically different (P = .29). Histologically, the grafts demonstrated limited cellular ingrowth at both anstomoses, with fibrin matrix along the remainder of the blood-biomaterial interface. These data suggest that, similar to Dacron, exposure to an ePTFE surface results in significant changes in platelet biology, and these platelet-ePTFE interactions persist even after the graft has formed a mature pseudointima. The pseudointima appears to be the primary determinant of the blood-biomaterial interaction. © 1995 John Wiley & Sons, Inc.

Notes: Prosthetic arterial graft infection continues to be a significant and often devastating complication of vascular surgery. The organisms Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) are the primary pathogens causing acute and late graft infections, respectively.The objective of this study was to develop an infection-resistant prosthetic arterial graft by applying the bacteriocidal quinolone antibiotic ciprofloxacin to polyethylene terepthalate (Dacron) via thermofixation (pad/heat), a new application method founded on established textile procedures. We hypothesize that the limited fibrophilic characteristics of ciprofloxacin will permit binding to Dacron and at the same time allow persistent controlled release over an extended period of time. Using pad/heat technology, 33 μg (± 2.97 μg, n = 12) of ciprofloxacin was successfully bound to a 1-cm2 piece of woven Dacron. A full complement of microbiologic assays demonstrated superior, sustained antistaphylococcal activity of the pad/heat Dacron when compared to Dacron dipped into an equivalent concentration of ciprofloxacin. The sustained antimicrobial efficacy of ciprofloxacin pad/heat-treated Dacron opens new avenues in the development of infection-resistant biomaterials based on an understanding of textile chemistry. © 1993 John Wiley & Sons, Inc.