Vascular closure system type of nonpenetrating arcuate-legged titanium clips for graft-artery and graft-graft anastomoses: review of our clinical experience.

Abstract

To assess the durability of Vascular Closure System (VCS) clips for graft-artery and graft-graft anastomoses. The subjects were 100 consecutive patients, who had undergone vascular procedures in which VCS clip application was attempted for anastomoses. The operative indications were arteriosclerosis obliterans in 69 patients, aortic aneurysm in 26, and other disorders in 5. Large clips were used for both graft-artery and graft-graft anastomoses, and medium-sized clips were used for the smaller caliber femoral or popliteal arteries. Vascular Closure System clips could not be applied to anastomose the graft to the artery in 13 patients because the arterial wall was too thick or stiff. Anastomosis was accomplished without any problems in 80 patients, although suture-line bleeding occurred in 7 patients. This was ameliorated by an additional clip in four patients, but interrupted sutures were needed to seal the anastomosis in the other three patients. The 1-, 3-, and 5-year cumulative primary patency rates were 98.7%, 97.4%, and 87.7%, respectively. There were two graft failures and two anastomotic aneurysms. Vascular Closure System clips were useful to coapt a prosthetic graft to an artery unless the arterial wall was thicker than 2 mm or calcified. Thus, VCS clips could be durable enough for graft-artery anastomoses in the iliac or popliteal region.