Abstract
Nitinol and titanium vascular anastomotic clips were introduced in access surgery more than a decade ago. Compared to sutured anastomoses, clipped ones are performed faster,1 with fewer bleeding and infectious complications,2 while improved maturation,3 and better primary,2,3 and secondary patency of autogenous arteriovenous fistulas (AVFs) and prosthetic grafts have been reported in most studies.2–6 Improved outcomes might be the result of reduced neointimal hyperplasia (NIH) as shown in AVF and non-AVF models,7 improved anastomotic compliance,8 preservation of endothelial function,9 minimized endothelial/vessel wall trauma and reduced thrombosis potential, and perhaps bias due to slight differences in technique.
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