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.
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.
Authors: Laura M Dember; Peter B Imrey; Gerald J Beck; Alfred K Cheung; Jonathan Himmelfarb; Thomas S Huber; John W Kusek; Prabir Roy-Chaudhury; Miguel A Vazquez; Charles E Alpers; Michelle L Robbin; Joseph A Vita; Tom Greene; Jennifer J Gassman; Harold I Feldman Journal: Am J Kidney Dis Date: 2013-08-28 Impact factor: 8.860
Authors: Patricia A Valusek; Troy L Spilde; KuoJen Tsao; Shawn D St Peter; George W Holcomb; Daniel J Ostlie Journal: Surg Endosc Date: 2007-02-16 Impact factor: 4.584
Authors: Jennifer M MacRae; Matthew Oliver; Edward Clark; Christine Dipchand; Swapnil Hiremath; Joanne Kappel; Mercedeh Kiaii; Charmaine Lok; Rick Luscombe; Lisa M Miller; Louise Moist Journal: Can J Kidney Health Dis Date: 2016-09-27