Vascular clips in anastomoses of femoropopliteal arterial reconstruction

Abstract

The vascular anastomoses are usually made with sutures. Some mainly experimental studies have been published about a new method of doing the vascular anastomoses with metal clips. We studied the suitability of vascular closure staple (VCS) clip applier system for making the anastomoses in femoropopliteal and femorotibial arterial reconstruction. During an 11-month period, VCS clips were used in 17 out of 27 patients who were operated due to severe claudication or incipient gangrena of the foot. Altogether 26 anastomoses were made with VCS clips using either great saphenous vein or PTFE graft. The making of anastomosis was easy and reliable. No postoperative bleeding was noticed. All anastomoses were patent 4-6 weeks postoperatively studied by palpation and measured by ankle brachial pressure index (mean 0.96). In Duplex Doppler examination all studied patients had well patent anastomoses on an average 11 months after the operation. With VCS clip applier system, it is possible to do anastomoses in arteriosclerotic arteries like in femoropopliteal reconstructions. This method helps making reliable anastomoses more easily.

Four-year surveillance study of metal clip anastomoses in peripheral arterial reconstruction

“…Correction was achieved by using extra polypropylene sutures or extra clips. In addition, we noticed that the usual problem with PTFE grafts (leaking from the needle-puncture point) was not seen when using VCS clips, because the clips do not penetrate the inner surface of the PTFE graft [11]. The long-term surveillance data on using vascular closure clips in making arterial anastomoses of peripheral bypasses in atherosclerotic patients seems to be encouraging.…”

“…using nonpenetrating titanium-based VCS clips in making the anastomoses [11]. The clips used were large (clip dimension at the tip, 2.0 mm).…”

“…The limited experience applying the clips in atherosclerotic vessels and the lack of long-term follow-up have been the main factors discouraging wider acceptance of this device. Our purpose was to study the patency of titanium clip anastomoses which had been done four years ago in lower-limb arterial reconstructions [11].…”

“…Its use in various types of small and large vessels has been studied mainly experimentally in animals [2][3][4][5][6][7]. There are only a few studies in which VCS clips have been used in clinical practice: in creation of arteriovenous fistulae for hemodialysis [8], for coronary anastomosis [9], for carotid arteriotomy closure after endarterectomy [10], and in anastomosis of peripheral arterial reconstructions [11]. Because the reconstruction time with VCS clips is shorter than with sutures, Leppa¨niemi et al [12] have suggested that this device could serve as a viable alternative to standard suture reconstruction techniques in cases such as multiple vascular trauma when it is important to reduce warm ischemic time, and in situations where the crossclamping time should be kept to a minimum.…”