Sutureless vascular reconstruction with titanium clips

Attempts to find alternatives to sutured vascular reconstruction techniques has continued for decades and include various forms of rings, tubes, endol uminal stents as well as gluing or welding techniques of large Vessel anast omoses. One recently introduced technique uses nonpenetrating titanium clip s 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 o r fibrosis, and are considerably faster to apply when compared to standard suture techniques. Although there are some clinical reports of defective cl ipped closures causing postoperative bleeding complications, they are rare and most probably related to technical errors in applying the clips. The ma in disadvantages of the clips include the limited experience of their appli cability in atherosclerotic vessels, lack of long term follow-up and cost. Potentially, the clips could be useful in the repair of multiple vascular i njuries, in vessel repair or ligation performed in confined spaces, and in vascular procedures requiring the shortest possible cross-clamping time. Fu ture applications could include endoscopic procedures as well as the use of a one-shot device which simultaneously applies up to a dozen clips to symm etrically everted and approximated vessel edges.