Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy
Introduction: Current agents for the intravascular embolization of traumatic hemorrhage are used off-label and have been minimally studied with respect to their performance under differing coagulation conditions. We studied the hemorrhage control efficacy of a novel, liquid, polyethylene glycol-base...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-01-01
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| Series: | JVS - Vascular Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666350321000043 |
| _version_ | 1819175496413347840 |
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| author | David S. Kauvar, MD, MPH, FSVS, FACS I. Amy Polykratis, BS Rodolfo De Guzman, BS M. Dale Prince, BS Amber Voelker, BS Bijan S. Kheirabadi, PhD Michael A. Dubick, PhD (deceased) |
| author_facet | David S. Kauvar, MD, MPH, FSVS, FACS I. Amy Polykratis, BS Rodolfo De Guzman, BS M. Dale Prince, BS Amber Voelker, BS Bijan S. Kheirabadi, PhD Michael A. Dubick, PhD (deceased) |
| author_sort | David S. Kauvar, MD, MPH, FSVS, FACS |
| collection | DOAJ |
| description | Introduction: Current agents for the intravascular embolization of traumatic hemorrhage are used off-label and have been minimally studied with respect to their performance under differing coagulation conditions. We studied the hemorrhage control efficacy of a novel, liquid, polyethylene glycol-based hydrogel delivered as two liquid precursors that polymerize within the target vessel in a unique animal model of severe solid organ injury with and without dilutional coagulopathy. Methods: Anesthetized swine (n = 36, 45 ± 3 kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33°C-35°C (coagulopathic group). All animals had controlled 20 mL/kg hemorrhage and endovascular proximal splenic artery access with a 4F catheter via a right femoral sheath. Splenic transection and 5-minute free bleeding were followed by treatment (n = 5/group) with 5 mL of gelfoam slurry, three 6-mm coils, up to 6 mL of hydrogel, or no treatment (n = 3, control). Animals received 15 mL/kg plasma and were monitored for 6 hours with continuous blood loss measurement. Results: Coagulopathy was successfully established, with coagulopathic animals having greater pretreatment blood loss and earlier mean time to death regardless of the treatment group. All control animals died within 100 minutes. Overall survival without coagulopathy was 5/5 for hydrogel, 4/5 for coil, and 3/5 for gelfoam. With coagulopathy, one hydrogel animal survived to the end of the experiment, with 2/4 hydrogel deaths occurring in the final hour of observation. In noncoagulopathic animals, hydrogel demonstrated improved survival time (P < .01) and post-treatment blood loss (1.46 ± 0.8 mL/kg) over controls (18.8 ± 0.7, P = .001), gelfoam (4.7 ± 1.3, P > .05), and coils (4.6 ± 1.5, P > .05). In coagulopathic animals, hydrogel had improved survival time (P = .003) and decreased blood loss (4.2 ± 0.8 mL/kg) compared with control (20.4 ± 4.2, P = .003). Conclusions: The hydrogel demonstrated equivalent hemorrhage control performance to standard treatments under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent should be explored as a potential preferable treatment for the embolization of traumatic solid organ and other injuries. (JVS–Vascular Science 2021;2:43-51.) Clinical Relevance: In a translational model of severe solid organ injury hemorrhage with and without coagulopathy, a novel hydrogel transarterial embolization agent demonstrated equivalent hemorrhage control performance to standard agents under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent represents a promising future treatment for the embolization of traumatic solid organ and other injuries. |
| first_indexed | 2024-12-22T20:55:47Z |
| format | Article |
| id | doaj.art-3616ba14d1924d6287637a8457fbb90e |
| institution | Directory Open Access Journal |
| issn | 2666-3503 |
| language | English |
| last_indexed | 2024-12-22T20:55:47Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JVS - Vascular Science |
| spelling | doaj.art-3616ba14d1924d6287637a8457fbb90e2022-12-21T18:12:57ZengElsevierJVS - Vascular Science2666-35032021-01-0124351Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathyDavid S. Kauvar, MD, MPH, FSVS, FACS0I. Amy Polykratis, BS1Rodolfo De Guzman, BS2M. Dale Prince, BS3Amber Voelker, BS4Bijan S. Kheirabadi, PhD5Michael A. Dubick, PhD (deceased)6Vascular Surgery Service, Brooke Army Medical Center, JBSA Fort Sam Houston, Tex; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md; Correspondence: David S. Kauvar, MD, MPH, FSVS, FACS, Brooke Army Medical Center, 3551 Roger Brooke Dr, JBSA Fort Sam Houston, TX 78234Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TexCombat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TexCombat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TexCombat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TexCombat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TexCombat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TexIntroduction: Current agents for the intravascular embolization of traumatic hemorrhage are used off-label and have been minimally studied with respect to their performance under differing coagulation conditions. We studied the hemorrhage control efficacy of a novel, liquid, polyethylene glycol-based hydrogel delivered as two liquid precursors that polymerize within the target vessel in a unique animal model of severe solid organ injury with and without dilutional coagulopathy. Methods: Anesthetized swine (n = 36, 45 ± 3 kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33°C-35°C (coagulopathic group). All animals had controlled 20 mL/kg hemorrhage and endovascular proximal splenic artery access with a 4F catheter via a right femoral sheath. Splenic transection and 5-minute free bleeding were followed by treatment (n = 5/group) with 5 mL of gelfoam slurry, three 6-mm coils, up to 6 mL of hydrogel, or no treatment (n = 3, control). Animals received 15 mL/kg plasma and were monitored for 6 hours with continuous blood loss measurement. Results: Coagulopathy was successfully established, with coagulopathic animals having greater pretreatment blood loss and earlier mean time to death regardless of the treatment group. All control animals died within 100 minutes. Overall survival without coagulopathy was 5/5 for hydrogel, 4/5 for coil, and 3/5 for gelfoam. With coagulopathy, one hydrogel animal survived to the end of the experiment, with 2/4 hydrogel deaths occurring in the final hour of observation. In noncoagulopathic animals, hydrogel demonstrated improved survival time (P < .01) and post-treatment blood loss (1.46 ± 0.8 mL/kg) over controls (18.8 ± 0.7, P = .001), gelfoam (4.7 ± 1.3, P > .05), and coils (4.6 ± 1.5, P > .05). In coagulopathic animals, hydrogel had improved survival time (P = .003) and decreased blood loss (4.2 ± 0.8 mL/kg) compared with control (20.4 ± 4.2, P = .003). Conclusions: The hydrogel demonstrated equivalent hemorrhage control performance to standard treatments under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent should be explored as a potential preferable treatment for the embolization of traumatic solid organ and other injuries. (JVS–Vascular Science 2021;2:43-51.) Clinical Relevance: In a translational model of severe solid organ injury hemorrhage with and without coagulopathy, a novel hydrogel transarterial embolization agent demonstrated equivalent hemorrhage control performance to standard agents under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent represents a promising future treatment for the embolization of traumatic solid organ and other injuries.http://www.sciencedirect.com/science/article/pii/S2666350321000043AngioembolizationSolid organ injuryHydrogelGelfoamEmbolization coilsEndovascular |
| spellingShingle | David S. Kauvar, MD, MPH, FSVS, FACS I. Amy Polykratis, BS Rodolfo De Guzman, BS M. Dale Prince, BS Amber Voelker, BS Bijan S. Kheirabadi, PhD Michael A. Dubick, PhD (deceased) Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy JVS - Vascular Science Angioembolization Solid organ injury Hydrogel Gelfoam Embolization coils Endovascular |
| title | Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy |
| title_full | Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy |
| title_fullStr | Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy |
| title_full_unstemmed | Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy |
| title_short | Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy |
| title_sort | evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy |
| topic | Angioembolization Solid organ injury Hydrogel Gelfoam Embolization coils Endovascular |
| url | http://www.sciencedirect.com/science/article/pii/S2666350321000043 |
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