title: Five years' world experience with nonpenetrating clips for vascular anastomoses.
abstract: BACKGROUND
  A new sutureless technique has been introduced clinically to facilitate the process of vascular reconstruction and improve patency. The Vessel Closure System (VCS) is nonpenetrating, creates an elastomeric everted anastomosis, and is easily and reproducibly applied. The objective of this report is to review the published world experience that has accrued regarding these clips with attention to the assets, liabilities, and pitfalls associated with the new technology.
  
  
  METHODS
  Medline search and manual cross-referencing were performed, after which 61 original articles were identified on the use of VCS clips for vascular anastomoses.
  
  
  RESULTS
  Advantages of the clips compared with sutures include the technical ease of application, the reduced anastomotic time, the superior hemodynamics, and the improved healing pattern of the anastomosis. Disadvantages include the potential problems in atherosclerotic vessels, lack of prospective randomized long-term follow-up, and initial costs. The best clinical results have been achieved in microvascular repair, as well as with vascular access and transplantation surgery.
  
  
  CONCLUSIONS
  The VCS clip technology has become an accepted vascular anastomosing technique, which in future could lead to the use of clips as a standard approach and the use of sutures only in case of severe atherosclerosis and other circumstances in which vessel edges are difficult to evert.
authors.affiliation: Department of Surgery, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands. czeebregts@hotmail.com
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: Wolff M
authors.initials: WM
authors.lastname: Kirsch
authors.forename: Jan J
authors.initials: JJ
authors.lastname: van den Dungen
authors.forename: Yong H
authors.initials: YH
authors.lastname: Zhu
authors.forename: Reinout
authors.initials: R
authors.lastname: van Schilfgaarde
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery; D001026:Coronary Artery Bypass; D006801:Humans; D013525:Surgical Instruments; D013536:Suture Techniques; D014656:Vascular Surgical Procedures / Q000295:instrumentation*