A prospective evaluation of interrupted nitinol surgical clips in arteriovenous fistula for hemodialysis.
BACKGROUND
The use of a self-closing nitinol surgical clip (Coalescent Surgical U-Clip) is a novel technique of creating an interrupted vascular anastomosis, which also eliminates the knot tying associated with a conventional vascular anastomosis. The purpose of this study was to compare the clinical outcome of arteriovenous fistulae (AVF) for hemodialysis as constructed using interrupted U-Clip devices and conventional continuous polypropylene sutures.


METHODS
We prospectively studied the clinical course of 132 patients (149 access) undergoing either forearm autologous arteriovenous fistula (FAVF, n = 69) or upper arm autologous arteriovenous fistula (UAVF, n = 80) or creations during a 39-month period. Among the FAVF, U-Clips and polypropylene sutures were used in 37 and 32 anastomoses, respectively. Among the UAVF, U-Clips and polypropylene sutures were used in 41 and 30 anastomoses, respectively. Primary patency, complication, and maturation rates were analyzed.


RESULTS
Clipped FAVF had an improved maturation rate at 6 weeks (32 of 37, 86%) when compared with sutured FAVF (22 of 32, 69%, P <0.05). There was no difference in the maturation rate among UAVF constructed with either U-Clips or sutures (88% versus 87%, not significant). The primary patency rates at 12, 24, and 36 months were 91%, 84%, and 75% for the clipped FAVF; and 83%, 74%, and 61% for the sutured FAVF (P <0.05) There was no difference in the patency rate of UAVF constructed with either U-Clips or polypropylene sutures at either 12, 24 or 36 moths (91%, 80%, and 75% versus 83%, 77%, and 69%, respectively).


CONCLUSIONS
The U-Clips are a viable alternative to sutures for creating vascular anastomosis. It provides a improved maturation and patency rates when compared with the conventional sutured AVF in the forearm. The clinical benefit of the U-Clips may be due in part to the improved compliance created by the interrupted anastomotic technique.
Lin
Peter H
PH
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, Houston VAMC (112), Houston, TX 77030, USA. plin@bcm.tmc.edu
Bush
Ruth L
RL
Nelson
Jonathan C
JC
Lam
Russell
R
Paladugu
Ramesh
R
Chen
Changyi
C
Quinn
Gene
G
Lumsden
Alan B
AB
D000328:Adult; D000497:Alloys; D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D011446:Prospective Studies; D006435:Renal Dialysis; D013525:Surgical Instruments; D016019:Survival Analysis; D013537:Sutures; D014654:Vascular Patency
D000497:Alloys; D011126:Polypropylenes; C013616:nitinol