Direct rubbing technique: A simple and effective method for applying aquabrid® for anastomotic hemostasis

• Anastomotic needle-hole bleeding remains difficult to control in aortic surgery • Aquabrid® allows effective hemostasis under wet and zero-pressure conditionsA direct rubbing technique enables ultra-thin, uniform sealant application • The technique preserves visibility and allows additional suturing if needed • Felt- and pledget-free anastomotic hemostasis may reduce material use and complexity Various hemostatic agents are available for cardiovascular surgery, and their appropriate selection and application are essential for controlling anastomotic bleeding. Aquabrid® is a completely synthetic surgical sealant that reacts with water to form an elastic polymer and is particularly effective under wet or bloody operative conditions. Although several applications of Aquabrid® have been reported, optimal techniques for achieving uniform, ultra-thin application remain limited. We describe a simple, practical, and reproducible technique for prophylactic hemostasis of aortic or vascular graft anastomoses using direct finger application of Aquabrid®. After completion of continuous or interrupted suturing under aortic clamping, without the use of felt or pledgets, approximately 0.2–0.25 mL of Aquabrid® is placed directly onto a dry gloved index finger. The material is gently rubbed circumferentially along the anastomotic line, beginning from the greater curvature side, and then spread into a thin, transparent film by lightly massaging between the index finger and thumb. This maneuver can be completed using a single finger, allowing precise control and even distribution. Because Aquabrid® polymerizes slowly and remains elastic, sufficient time is available for manipulation, and additional suturing can be performed if necessary. Effective hemostasis is achieved within approximately one minute, permitting early declamping without waiting for complete polymerization. This felt-free approach preserves visibility of needle holes, facilitates targeted hemostasis, and may reduce postoperative adhesions during reoperation. This direct rubbing technique enables efficient, ultra-thin application of Aquabrid® using a minimal amount of material and represents a useful adjunct for anastomotic hemostasis in aortic surgery.