Effective control of massive venous bleeding by "multioverlapping therapy" using polysaccharide nanosheets in a rabbit inferior vena cava injury model

Objective: To investigate the efficacy of multioverlapping therapy using a polysaccharide nanosheet having 75-nm thickness for sealing and stopping massive venous hemorrhage. Methods: The hydrostatic durability of the polysaccharide nanosheet was evaluated invitro when secured to an incised silicon tube. For invivo studies, the inferior vena cava (IVC) of rabbits was cut longitudinally, and multiple polysaccharide nanosheets were overlapped onto the injured IVC. Results: The mechanical hydrostatic durability of the nanosheets was gradually augmented by an increasing number of multilayered nanosheets invitro. This durability was saturated at 80± 6 mm Hg by four layers of nanosheets, which was robust enough to seal injured vessel walls of the large IVC. Multioverlapping therapy using nanosheets effectively sealed and stopped bleeding from the injured IVC invivo. One month later, no inflammatory tissue response was observed around the nanosheet attachment sites of the IVC, while conventional suturing repair in control rabbits showed a severe inflammatory response around the sutured area. Conclusions: The multioverlapping therapy using the polysaccharide nanosheets will effectively stop massive venous bleeding without adverse effects in the immediate or chronic postoperative setting. Clinical Relevance: Suturing repair is usually performed for perforated bleeding from proximal central veins such as the inferior vena cava; ligation of large veins is a limited option for damage control surgery. This study demonstrates the preliminary results of novel polysaccharide nanosheets for sutureless treatment to stop bleeding from the inferior vena cava. If these results are confirmed in humans with a significantly improved hemostasis maneuver, they would have a great advantage for surgical operation, especially in trauma patients with bleeding from large veins.