Evaluation of a Porcine Vascular Model to Assess the Efficacy of Various Hemostatic Techniques

ABSTRACT

Background: A novel live porcine model replicated the endoscopic surgical field of a carotid arterial injury of the human skull base. Hemostatic techniques were applied to jugular venous and carotid arterial injuries, including muscle patches, hemoclips, and aneurysm clips. Doppler imaging distal to the injury assessed flow through the repaired vessel. Materials and Methods: External jugular veins, and internal carotid arteries isolated from seven live anesthetized 100 kg pigs, were placed into a sinus model otorhino neuro trainer for visualization via an endoscopic nasal approach. Vessels were systematically injured and repaired, and Doppler measurements were made to assess flow through the vessels before injury and following repair. Results and Conclusions: Blood pressures were maintained within physiological ranges, despite blood losses of up to 4.5 l. Venous injuries were repaired using Floseal, hemoclips, and aneurysm clips, while arterial injuries were repaired with muscle patches and aneurysm clips. Blood flow remained in all vessels after repair. This porcine model was effective for demonstration of arterial and venous injuries during endoscopic skull base surgery. Crushed muscle patch was effective for arterial injuries of 3 mm, and the aneurysm clips for injuries of 5 mm. Jugular venous injuries of 3 mm were repaired using Floseal, 5 mm using hemoclips, and 6 mm using aneurysm clips. Doppler imaging was a noninvasive means of demonstrating ongoing flow through injured and repaired vessels. The model represents a valuable training tool with the potential to train endoscopic skull base teams the skills required to manage an internal carotid artery injury.

Keywords: :

• hemostasis
• aneurysm clip
• hemoclip
• muscle patch
• Floseal
• porcine model
• endoscopic skull base surgery

Notes

1 Medtronic, Jacksonville, FL, USA.

2 Baxter International, Inc., Deerfield, IL, USA.

3 Surgicel Nu-knit; Ethicon, Inc., Somerville, NJ, USA.

4 Rompun; Bayer Health care Global.

5 Alfasan International B.V., Holland.

6 Atlantic Laboratories; Thailand.

7 BD Insyte, Becton Dickinson Infusion Systems, UT 84070, USA.

8 Jurox, Australia.

9 Vetofol, Norbrook Laboratories Limited, Northern Ireland.

10 Temgesic, RB Pharmaceuticals Ltd, UK.

11 Isoptin; Abbott, Australasia.

12 Norcuron®; Organon Pharmaceuticals, USA.

13 Baxter Healthcare Corporation, Deerfield, IL, USA.

14 Hibitane Skin Cleanser, Zeneca, Ltd., Ireland.

15 SIMONT, Pro Delphus, Pernambuco, Brazil.

16 Logiq E, GE Corporation, USA.

17 Weck Hemoclips, Teleflex Medical, NC 27709, USA.

18 Sugita Titanium Aneurysm Clip; Mizuho Ikakogyo Co. Ltd., Japan.

19 Medtronic ENT, Jacksonville, FL, USA.

20 Lethabarb, Virbac, (Australia) Pty Ltd.