TECHNICAL NOTES   

International Angiology 2000 March;19(1):69-74

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

Sutureless vascular reconstruction with titanium clips

Leppäniemi A., Rich N., Pikoulis E., Rhee P., Burris D., Wherry D.

From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

Attempts to find alter­na­tives to ­sutured vas­cu­lar recon­struc­tion tech­niques has con­tin­ued for ­decades and ­include var­i­ous forms of rings, tubes, endo­lu­mi­nal ­stents as well as ­gluing or weld­ing tech­niques of large ves­sel anas­to­mos­es. One recent­ly intro­duced tech­nique uses non­pen­e­trat­ing tita­ni­um clips for evert­ed ves­sel approx­i­ma­tion and clo­sure. Experimental work on their use in var­i­ous types of large ves­sel ­repairs and recon­struc­tions has ­shown that the clips are eas­i­ly ­applied with a short learn­ing curve, ­create good con­di­tions for ves­sel wall heal­ing with­out caus­ing exces­sive inflam­ma­tion or fibro­sis, and are con­sid­er­ably fast­er to apply when com­pared to stan­dard ­suture tech­niques. Although there are some clin­i­cal ­reports of defec­tive ­clipped clo­sures caus­ing post­op­er­a­tive bleed­ing com­pli­ca­tions, they are rare and most prob­ably relat­ed to tech­ni­cal ­errors in apply­ing the clips. The main dis­ad­van­tag­es of the clips ­include the lim­it­ed expe­ri­ence of their appli­cabil­ity in ath­e­ros­cle­rot­ic ves­sels, lack of long term fol­low-up and cost. Potentially, the clips could be use­ful in the ­repair of mul­ti­ple vas­cu­lar inju­ries, in ves­sel ­repair or liga­tion per­formed in con­fined spac­es, and in vas­cu­lar pro­ce­dures requir­ing the short­est pos­sible cross-clamp­ing time. Future appli­ca­tions could ­include endo­scop­ic pro­ce­dures as well as the use of a one-shot ­device which simul­ta­ne­ous­ly ­applies up to a dozen clips to sym­met­ri­cal­ly evert­ed and approx­i­mat­ed ves­sel edges.