FACILITATED VASCULAR ANASTOMOSES - THE ONE-SHOT DEVICE

Background. A mechanical system for facilitating vascular anastomosis (end-to-side, end-to-end) is described that enables the rapid construc tion of nonpenetrated, compliant junctions. The instrument (United Sta tes Surgical One-Shot system) simultaneously applies either 10 or 12 n onpenetrating, arcuate-legged titanium clips to everted vessel or pros thetic conduit edges. Methods and Results. The instrument has been tes ted in animals (jugular and femoral vein jump grafts in carotid and fe moral arteries, interpositional grafts, 20 pigs) and human cadaveric c onstructs (saphenous veins to left anterior descending coronary arteri es, 20 cases, 5 brachiocephalic access fistulas) as end-to-side constr ucts. Clipped constructs have equivalent or superior physical properti es to control sutured constructs (6-0 polypropylene) as gauged by burs t and tensile strength. All studies were performed under Food and Drug Administration Good Laboratory Practice standards, and the device has been approved for marketing by the Food and Drug Administration. Conc lusions. The device enables rapid and reproducible vascular anastomoti c constructs with vessels as small as 1.8 mm outer diameter. The const ructs are flanged, interrupted, and nonpenetrated.