Preliminary prospective randomized experience with vascular clips in the creation of arteriovenous fistulae for hemodialysis.
BACKGROUND
A new vascular clipping system (VCS) has been introduced for clinical use. This study was developed to determine whether patency rates and treatment outcomes for anastomoses in hemodialysis access surgery can be improved by the application of this new technology.


METHODS
During a 10-month period, 96 consecutive patients requiring autologous fistula, synthetic fistula, or graft revisions for hemodialysis were prospectively randomized into two treatment groups. Anastomoses were constructed with the VCS in 46 patients and with polytetrafluoroethylene (PTFE) suturing in 49 patients. The procedures were performed in an outpatient setting, at a large medical center, by one surgeon. Time to construct the anastomosis, amount of bleeding from the anastomotic site, and primary and secondary graft patencies were analyzed.


RESULTS
The mean time to construct anastomoses in autologous and synthetic grafts using VCS clips was significantly shorter than with sutures (autologous 14 versus 22 minutes, P = 0.0001; and new grafts 26 versus 30 minutes, P = 0.04). Blood loss was less in anastomoses done with the VCS clip; however, statistical significance was reached only for autologous fistulas (P = 0.0001). At 2-year follow-up, primary and secondary patencies were similar for both the VCS and suture groups with the exception that a statistically significant improvement was found in secondary patency for autologous fistulas when performed with the VCS.


CONCLUSIONS
The VCS clip is easy to use and produces a more rapid anastomosis with less bleeding. Primary and secondary patencies using the VCS clip were equivalent or improved when compared with standard suture. In our experience, no complications have been attributed to the use of the clip technique.
Schild
A F
AF
Department of Surgery, University of Miami, Florida 33136, USA.
Raines
J
J
D000714:Anastomosis, Surgical / Q000379:methods; D001164:Arteriovenous Fistula; D004867:Equipment Design; D005260:Female; D006085:Graft Survival; D006470:Hemorrhage; D006801:Humans; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013525:Surgical Instruments; D013537:Sutures
D011138:Polytetrafluoroethylene