Arteriotomy Closure With Glued Patch In The Rabbit Carotid Artery

BACKGROUND: Although carotid endarterectomy (CEA) is recognized today as the treatment of choice for selected patients with symptomatic or asymptomatic, severe, extracranial internal carotid artery stenosis, the efficacy of surgical therapy is predicated on perioperative morbidity and mortality rates to be minimal. If the complication rate of CEA is too high during the perioperative period, it will offset the beneficial side of CEA in the prevention of stroke from carotid stenosis. Obviously, a protocol to let CEA become simpler, easier and safer to perform will greatly reduce the complications resulted from the operation itself.Purpose: to investigate the effect of the glue-2-octyl cyanoacrylate-on thearteriotomy of the rabbit carotid artery through in vitro and in vivo experiment and provide the foundation for its clinical use in CEA.Methods: 1. To test the pressure which the glued patch with 2-octyl cyanoacrylate can withstand: (1) in vitro, the carotid arteries of the porcine were procured from the local slaughterhouse, then arteriotomy was done and closed by glued patch. A pressure transducer was attached to the vessel and saline solution forcefully infused.(2) in vivo, the rabbit carotid arteriotomy in one side was closed by the glued patch, on the other side, a pressure transducer was attached to the carotidartery, and then an acute experimental hypertension of the rabbit was induced by intravenous infusion of noradrenlin. 2. Using New Zealand Rabbits, an animal model of carotid atherosclerotic stenosis with hypertension was created by air-drying (120ml/min X 15min) an isolated segment of common carotid artery (about 2cm) and "two-kidney, one -clip" method and a diet of 2% cholesterol, 6% peanut oil for 2 months. 3. During operation, carotid ateriotomy in one side was closed by the glued patch which came from the carotid vein or Dacron, the other side was closed by the conventional suturing with 9-0 prolene silk as the control. 4. In order to prevent the glue getting into the lumen, a soluble intravascular stent made of Gelatin as a supplementary instrument of anastomosis was used. 5. The animals were sacrificed at 3 days, 14days, Sweeks and lOweeks (for CEA group) after operation and the arteries were examined by high-resolution color Doppler ultrasound, angiography and histological analysis before sacrifice.Results: 1. In vivo, 2-octylcyanoacrylate glue can easily hold a pressure of 175mmHg and in vitro it was tested up to 270 mmHg without leakage. 2. the time required to close arteriotomies by conventional suturing was 45.2±10.2 minutes from the beginning to 21.4±5.3 minutes in the end (p<0.01); the time needed for glued patch on arteriotomy closure did not surpass 10 minutes and varied little (P>0.05). Accordingly, compared with the control side, the time of carotid artery occlusion in the experimental side reduced greatly (p<0.01). 3. In all arteriotomies, 2-octylcyanoacrylate glue with patch provided quick sealing with complete hemostasis and all carotid arteries were patent at follow-up. 4. On histologica examination, 2-octylcyanoacrylate showed little toxicity and demonstrated a minimal inflammatory response; mural thrombus and medial necrosis or dissectionof the vessel wall were also not found. 5. 10 weeks after CEA, common areas of vessels and remaining areas of vessels were significantly different between the glued patch and conventional suturing (P<0.05).Conclusion: 1. arteriotomy closure by glued patch is simple, quick and safe. 2.2-octylcyanoacrylate showed little toxicity which did not affect the patent of the blood vessel. 3. Glued patch which was used in CEA can reduce the complication rate such as cerebral ischemia resulted from the clamping of carotid artery for a too long time. 4. It laid a foundation for performing CEA with the aid of endoscopic instrumentation in the future.