Analysis of nonpenetrating clips versus sutures for arterial venous graft anastomosis

The use of nonpenetrating clips (NPC) for vascular anastomosis is quickly b ecoming accepted. Studies attest to decreased anastomotic time, comparable patency rates, and decreased blood loss. Few human studies on the use of NP C have been done to date. The purpose of this study was to evaluate primary patency rates, operative time, and complications associated with NPC compa red to those with standard sutures for arterial venous graft (AVG). We retr ospectively reviewed the clinical course of 82 patients with a mean age of 45 years (range, 22 to 87) from February 1996 to July 1999. All patients un derwent upper extremity AVG construction. The procedures were performed at a single institution, by a single, well-experienced surgeon who has extensi ve experience with NPC. Primary patency rates, operative time, and complica tions were analyzed. Overall thrombotic incidence of AVG when NPC were used (27/48, 56%) was similar to that of sutures (17/34, 50%). Thrombotic incid ence within the first year was similar as well (23/48, 48% and 13/34, 38%). The mean time to primary thrombosis was similar in both groups (6.9 and 6. 8 months). The operative time required to construct an AVG with NPC (83 min ) was significantly less than that with sutures (96 min) (p = 0.015), There was no significant difference in incidence of graft infection or pseudoane urysm formation. NPC for AVG reduced operative time and resulted in primary patency and complication rates similar to those associated with use of sut ures. The mean time to primary thrombosis was similar for both groups. Our findings suggest an intimal hyperplastic response of a similar nature resul ting in thrombosis of both NPC and sutured AVGs.