The prevention of carotid artery rupture with isobutyl-2-cyanoacrylate

Carotid artery exposure and rupture is one of the most feared complications of head and neck surgery. The ideal method for preventing rupture of an exposed artery should be easy to perform, safe, effective and should spare local and regional flaps for later use in reconstruction. Isobutyl-2-cyanoacrylate (Bucrylate) is a commercially available compound that appears to meet these criteria. Test animals were divided into two groups. The carotid arteries of 12 dogs (group A) were exteriorized bilaterally and coated with Bucrylate unilaterally. Group B (four dogs) underwent the same procedure except that the vessels were bilaterally coated. Wounds were dressed twice daily with moist-to-dry gauze. No antibiotics were given. Nine of the 12 unprotected arteries in group A ruptured within 2 weeks, and one unprotected artery ruptured on postoperative day (POD) 29. Two dogs healed over both vessels. In group B, three dogs ruptured their arteries within 2 weeks. One dog healed over both vessels. Gross and histologic examination of the arteries showed a striking difference between coated and uncoated vessels. We believe that Bucrylate and cyanoacrylate adhesives hold promise in the clinical protection of exposed carotid arteries.