CAROTID ARTERIOTOMY CLOSURE USING A VASCULAR CLIP SYSTEM

PURPOSE: To compare a newly released vascular clip system (Vascular Cl ip-applier System; Auto Suture Company, Norwalk, CT) designed for sutu reless vessel closures and anastomoses with standard suture closure of carotid arteriotomies after carotid endarterectomies. PATIENTS AND ME THODS: Sixteen consecutive patients with symptomatic and severe caroti d stenoses were randomly allocated to receive either standard suture ( running 6-0 monofilament) or clip artery closures after undergoing car otid endarterectomies. The speed of arteriotomy closure was calculated for each procedure, and hemostasis, complications, and postoperative carotid patency were determined and recorded for each patient. RESULTS : The clip applier system performed well, and arteriotomy closure with clips was significantly faster than suture closure (0.36 cm/min in th e sutured group versus 0.52 cm/min in the clipped group, P = 0.019). C arotid patency assessed by ultrasonography 4 to 8 weeks after surgery showed that all arteries in both groups were patent. Two hemostasis pr oblems occurred in the clip closure group, one minor that was caused b y the use of incorrect clip size and one major that was probably cause d by a combination of sudden arterial hypertension and clip failure. T his complication resulted in a large neck hematoma and cross-clamp isc hemia during the ensuing suture repair of the arterial dehiscence. CON CLUSIONS: As a result of this small study, we determined that clip clo sure of carotid arteriotomies was feasible, but it remains questionabl e whether the increased speed of a sutureless closure is clinically im portant for this procedure. Concerns regarding the strength of clip cl osure of an endarterectomized vessel and the cost of clip closure comp ared with standard suture techniques suggest that there may be no clin ically significant benefits of arterial clip closure over suture closu re after carotid endarterectomy, and there is potentially some risk.