Vascular Closure Staple Clips Research Articles

Four-year surveillance study of metal clip anastomoses in peripheral arterial reconstruction

In our preliminary study four years ago, using vascular closure staple (VCS) clips in making arterial anastomoses in peripheral vascular reconstructions, we showed that clip closure is easy and safe in early long-term (an average of 11 months) follow-up. In the present study we re-examined all the patients who had been bypassed using VCS clips in our earlier study. All together, ten of 17 patients were clinically examined, the ankle brachial index was measured, and a duplex Doppler examination was performed. The mean ankle brachial index in the operated leg of seven patients was 1.01 (range, 0.78–1.52). The anastomoses of nine patients were patent and neither turbulent blood flow nor aneurysms were seen. Only a PTFE prosthesis was occluded. The long-term experience of using metal clips in the peripheral vascular reconstructions seems to be encouraging, because the patency of grafts is good and no adverse reactions, such as aneurysms, were seen during the four-year surveillance period.

Vascular Clips in Anastomoses of Femoropopliteal Arterial Reconstruction.

The vascular anastomoses are usually made with sutures. Some mainly experimental studies have been published about a new method of doing the vascular anastomoses with metal clips. We studied the suitability of vascular closure staple (VCS) clip applier system for making the anastomoses in femoropopliteal and femorotibial arterial reconstruction. During an 11-month period, VCS clips were used in 17 out of 27 patients who were operated due to severe claudication or incipient gangrena of the foot. Altogether 26 anastomoses were made with VCS clips using either great saphenous vein or PTFE graft. The making of anastomosis was easy and reliable. No postoperative bleeding was noticed. All anastomoses were patent 4-6 weeks postoperatively studied by palpation and measured by ankle brachial pressure index (mean 0.96). In Duplex Doppler examination all studied patients had well patent anastomoses on an average 11 months after the operation. With VCS clip applier system, it is possible to do anastomoses in arteriosclerotic arteries like in femoropopliteal reconstructions. This method helps making reliable anastomoses more easily.

Vein and artery growth after anastomosis with vascular closure staple clips vs interrupted polypropylene suture: application in pediatric vascular surgery

Background/Purpose Alternatives are still being sought in vascular surgery to address the problem of arrested growth after anastomosis in growing vessels, and opinions differ widely regarding the most suitable technique. This study compared vascular growth and permeability after anastomosis using the latest-generation vascular closure staple (VCS) system and the conventional suture technique to ascertain which approach yielded better results. Methods Thirty 55-day-old lambs underwent end-to-end anastomosis of the carotid artery and jugular vein. Serial ultrasonography and angiography were carried out over the ensuing 6-month growth period, after which lambs were euthanized. Results Both VCS clips and polypropylene suture allowed longitudinal and transverse vessel growth; however, longitudinal growth was significantly greater in clip-closed vessels than in either sutured or untreated vessels. Conclusions The results obtained for vascular growth and permeability suggest that VCS clips may provide a suitable alternative to conventional suture in pediatric vascular surgery.

Use of the vascular closure staple clip applier in head and neck reconstructive surgery

One of the most difficult problems in head and neck reconstructive surgery is the long duration. Especially, microvascular anastomotic surgical procedures take most of the time. We use the VCS clip for microvascular anastomosis under microscope and report the technique in this article. This technique is easier and faster than the suture technique in the anastomosis of vessels of larger than 2 mm in diameter. The VCS clips have potential applications for many other surgeries of the head and neck, and more studies need to be done.

Use of the Vascular Closure Staple Clip Applier for Microvascular Anastomosis in Free-Flap Surgery

We report our initial experience using the vascular closure staple clip applier (a nonpenetrating titanium clip applied in an interrupted, everting fashion) for microvascular anastomosis in free-flap surgery. In total, 153 anastomoses were performed in 87 free flaps (174 potential anastomoses) using the vascular closure stapler between October of 1997 and June of 1999. In 66 flaps, both the arterial and venous anastomosis were performed with the clip applier, whereas in 21 flaps only the venous anastomosis was performed using the clips. A total of 146 anastomoses were performed in an end-to-end fashion, and seven were performed end-to-side. Of the 87 flaps there were 53 TRAM flaps, seven bilateral TRAM, five latissimus dorsi, four gastrocnemius, three rectus abdominis, two radial forearm fibula, and four Rubens fat-pad flaps. Seventy flaps were used for breast reconstruction, seven flaps for lower limb reconstruction, four flaps for head and neck reconstruction, and six flaps for chest wall/trunk reconstruction. There were no postoperative anastomotic complications of bleeding, thrombosis, or need for revision (100 percent patency rate), with a significantly reduced time for completion of anastomoses. The clip applier is a safe, reliable method for performing microvascular anastomoses, allowing reduced operating time and possible cost savings in free-flap surgery.

Improved instrumentation to facilitate laparoscopic ureteroureterostomy

SummaryVarious technical advances have been investigated in an attempt to simplify reconstructive laparoscopic surgery. We report the initial use of a non-perforating, titanium vascular closure staple (VCS) (US Surgical Corp., Norwalk, CT) in combination with a tissue approximator device for performing laparoscopic ureteroureterostomy (UU). 12 female, Yucatan mini-pigs were prospectively randomised to undergo laparoscopic ureteral transection at the level of the lower pole of the kidney. An end-to-end UU was performed using only the VCS clips in six animals and using VCS clips and a newly-designed tissue approximator (TA) in six animals. The ureteral stent was removed 10–12 days after UU. Retrograde pyelography and differential creatinine clearances (CrCI) were performed at 6 and 12 weeks following UU. At 12 weeks, the animals were euthanised and the site of the UU was examined grossly and histopathologically. A histological healing score [0 (excellent) to 15 (poor)] was determined for each UU. An average of 12 clips was used for the laparoscopic UU. Group A, stapled UU, had an operating time of 22.0 ± 14.7 min compared with Group B, stapled UU with TA, which had a time of 4.83 ± 4.78 min (p = 0.04). The change in ureteral diameter (mm) for Group A and Group B were found to be 0.06 ± 2.35 and 0.864 ± 3.18 respectively (p = 0.84). Healing scores for Group A and Group B were similar: 5.83 ± 2.64 and 5.83 ± 4.11, respectively (p = 0.94); change in CrCI were also similar 4.40 ± 8.88 and 1.30 ± 13.36 respectively (p = 0.55). At 12 weeks, no intraluminal clips or calcifications were found fluoroscopically or grossly. Healing scores were satisfactory, with minimal fibrosis or inflammation found at the site of the UU. However, in one animal, focal bone metaplasia was found at the staple site. The non-perforating VCS clip allows for the efficient performance of a laparoscopic UU; the tissue approximator further reduces the operative time and improves the accuracy of clip placement. The resulting anastomosis appears to heal well. A clinical trial using this instrumentation is currently in progress.

Arterial reconstruction with vascular clips is safe and quicker than sutured repair

Background: Non-penetrating, arcuate-legged vascular-closure staple clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger vessels. The purpose of this study was to compare vascular-closure staple clips to sutured anastomoses in common iliac arteries in a porcine model. Methods: In an experimental study, transected iliac arteries on both sides of 11 pigs were randomly assigned to end-to-end anastomosis performed with vascular-closure staple clips or interrupted 6-0 polypropylene sutures. Angiographic, macroscopic and microscopic results were assessed after 2 months. Results: There was no significant difference in the patency rate, tensile strength of the anastomoses, vessel diameter at the repair site, intimal thickness or wall thickness of the arteries after either method of closure. The mean (s.d.) clamp time was 19.8 (6.1) minutes for clip repair, and 36.0 (6.9) seconds for suture repair ( P<0.001). The times required for the reconstruction of the anastomoses were 17.4 (6.1) and 35.5 (7.1) minutes, respectively ( P<0.001). Conclusions: Arterial anastomoses performed with vascular-closure staple clips are faster than sutured anastomoses, and result in comparable wound healing when assessed for patency, tensile strength, degree of narrowing and intimal reaction.

Rapid Arterial Anastomosis with Titanium Clips

Background: The obvious advantages of rapid arterial anastomoses have prompted the continuing search for more rapid anastomotic techniques to complement the standard sutured anastomosis. Nonpenetrating, arcuate-legged titanium vascular closure staple (VCS) clips were initially developed for microvascular anastomoses. The purpose of this study was to compare VCS clips with sutured arterial end-to-end anastomosis in larger vessels. Methods: In 6 pigs, transacted iliac arteries were reanastomosed with VCS clips on one side and continuous 6-0 polypropylene suture on the other. Results: The reconstruction time was 8.4 ± 5.2 minutes for clip closure and 12.0 ± 6.6 minutes for suture closure ( P = 0.033). All vessels were patent half an hour after completing the anastomoses with no signs of early thrombosis. Conclusions: Arterial end-to-end anastomosis can be performed more rapidly with VCS clips than continuous sutures, and are potentially useful in situations where the clamp time of the vessel is critical.

Laparoscopic ureteroureterostomy using vascular closure staples in porcine model.

The greatest difficulty in performing a laparoscopic pyeloplasty is the suturing of the ureteropelvic junction. The purpose of this study was to evaluate the use of nonperforating titanium vascular closure staple (VCS) clips to perform in laparoscopic ureteroureterostomy in the porcine model. Six female minipigs underwent laparoscopic transection of one of the proximal ureters at the level of the lower pole of the kidney. Ureteroureterostomy was then performed using the titanium VCS clips. The animals were evaluated at 6 and 12 weeks postureteroureterostomy with retrograde pyelography and differential creatinine clearances. At 12 weeks, the animals were euthanized, and the area of ureteroureterostomy was examined grossly and histopathologically. The technique for laparoscopic vascular clipping of the ureteroureterostomy proved to be fast and effective. Follow-up indicated that the method was successful in producing a functionally patent anastomosis. No encrustation, stone formation, or intraluminal clip was noted in any of the ureters or kidneys undergoing the ureteroureterostomy. The area of the ureteroureterostomy showed minimal fibrosis and inflammation on histopathologic examination. In this animal study, the nonperforating titanium clips facilitated the performance of a laparoscopic ureteroureterostomy.

Ureteral Repair with Titanium Staples: Comparison with Suture Closure

Objectives. Vascular closure staple (VCS) clips made of titanium were initially developed for microvascular anastomoses with little knowledge of their effectiveness in larger tubular tissue structures. This study compares VCS clips and sutures in the closure of longitudinal ureterotomy incisions. Methods. In 9 pigs, 1-cm-long anterior, longitudinal ureterotomy incisions were randomly assigned to closure with either 4-0 interrupted polyglactin sutures or VCS clips. Results. Clip closure was significantly faster (74±28 versus 534±182 seconds). All 18 ureters were patent and without signs of leakage, calculus formation, or stenoses after 3 months. Clip closure resulted in slightly but not statistically significantly less narrowing of the duct lumen, but there was no difference in wall thickness at the repair site. At histologic examination, all 18 incisions healed without signs of acute inflammation or marked fibrosis. Conclusions. Ureterotomy closure with VCS clips results in wound healing that is as effective as suture closure, with a comparable degree of narrowing. The time required for clip closure is only about 1/7 that required for suture closure.

VASCULAR ANASTOMOSIS IN BLOOD ACCESS SURGERY FOR HEMODIALYSIS USING VASCULAR CLOSURE STAPLES

The titanium Vascular Closure Staple (VCS) clip application system which had been established for peripheral vascular anastomosis was used in blood access surgery for hemodialysis in our center. Subjects were ten patients undergone blood access operation between February and May of 1997. Operative procedures included arteriovenous fistula in two patients, artificial graft implantation in six patients, reconstruction of the radial artery in one patient, and closure of an artificial graft in one patient. In all patients the vascular anastomosis was completed by using VCS clips, when it took 12 minutes in an average for the artificial graft anastomosis and 8.5 minutes in an average for arteriovenous fistula. No bleeding from the anastomosed site occurred during surgery and after declamping. VCS clip is easy to deal with and shortens the time for anastomosis. On the other hand, VCS clip is expensive and a problem in the cost-performance is still unsolved. In the blood access surgery for hemodialysis, the use of this VCS clip appears beneficial especially for implantation and repair of artificial grafts.