Hemostatic effect of glue-lipiodol mixture plugged in the needle tract after renal biopsies in a high-risk, anticoagulated rabbit model.

RATIONALE AND OBJECTIVES

To investigate the hemostatic effect of a glue-lipiodol mixture plugged immediately into the needle tract after renal biopsy of high-risk, anticoagulated rabbits by use of a large-core gun biopsy needle and the subsequent pathological changes of the biopsy tract.

METHODS

Twenty-five rabbits weighing 2 kg were divided into five groups (five rabbits each) according to time of sacrifice at 0, 2, 4, 6, and 8 days after biopsy. After anesthesia was induced, both kidneys were exposed and a bolus of 100 U/kg heparin was administered intravenously. Blood sampling was done twice, once before and once after heparinization, and activated partial thromboplastin times were measured for each. Then renal biopsies were performed in 25 pairs of kidneys by using an 18-gauge automated biopsy gun. The glue-lipiodol mixture was not injected into the first biopsy sites (control). Immediately after the second biopsies were done, 0.5 mL of the glue-lipiodol mixture at a 1:3 ratio was plugged into the needle tract through the outer cannula while withdrawing it slowly. Bleeding times of the two biopsies of each pair of kidneys were measured. All rabbits were humanely killed at their previously scheduled times, and histopathological findings were evaluated for the presence of inflammation, necrosis, foreign body reaction, and fibrosis around the biopsy tract. All parameters were classified into four categories according to the degree of severity, from 0 to + + +.

RESULTS

Twenty-five cases (100%) of the controls bled after the biopsies were performed. Four of them (16%) showed immediate, massive, pulsatile bleeding. In contrast, only 11 of 25 cases (44%) bled at the second biopsy (plugged) sites and only two of them (8%) showed pulsatile bleeding. Mean bleeding times were 228 seconds in controls and 26 seconds in the glue-lipiodol mixture-plugged sites (P < 0.000). Histopathological examination of the needle tract in the plugged group revealed mild inflammation in the 0- to 2-day groups and moderate inflammation and mild necrosis in the 4- and 6-day groups. In the 8-day group, inflammation was diminished and only mild fibrosis was noted. There was no foreign body reaction in any of the specimens of the plugged group.

CONCLUSIONS

We conclude that a glue-lipiodol mixture, when used as a plug material for the renal biopsy tract, is an efficacious method of bleeding control that is associated with a low incidence of pathological alterations in an anticoagulated rabbit model, thus demonstrating its future potential for clinical application.