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Terranella S, Fefferman M, Zhang Y, Wright K, Hollinger E, Olaitan O, Hertl M, Jensik S, Keen R, Chan E. Economic evaluation of suture versus clip anastomosis in arteriovenous fistula creation. J Vasc Surg 2020; 73:2098-2104. [PMID: 33249206 DOI: 10.1016/j.jvs.2020.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Techniques such as the use of nonpenetrating vascular clips for arteriovenous fistula (AVF) anastomotic creation have been developed in an effort to reduce fistula-related complications. However, the outcomes data for the use of clips have remained equivocal, and the cost evaluations to support their use have been largely theoretical. Therefore, the present study aimed to determine both the clinical and the cost outcomes of AVFs created with nonpenetrating vascular clips compared with the continuous suture technique during a 10-year period at a single institution. METHODS All patients undergoing AVF creation in the upper extremity from 2009 through 2018 were retrospectively analyzed. The patient demographics and AVF outcomes were collected and compared stratified by the surgical technique used. A cost analysis was performed of a subgroup of patients from 2013 to 2018. RESULTS During the 10-year study period, 916 AVFs were created (79% using the continuous suture technique and 21% using nonpenetrating vascular clips). Patient demographics and comorbid conditions did not differ between the two groups, and no differences were present in maturation, primary patency, assisted primary patency, or complication rates between the two groups at 1 year. The suture group had a shorter time to maturation (4.3 months vs 5.5 months; P < .01) and improved secondary patency compared with the clip group (77.13% vs 69.59%; P = .03) The cost analysis of the procedures revealed a significant difference in direct costs (suture, $1389.26 vs clip, $1716.51; P < .01) and contribution margin (suture, $1770.19 vs clip, $1128.36; P < .01) for the two groups. CONCLUSIONS Both suture and clip techniques in AVF creation demonstrated equivalent rates of maturation, primary patency, assisted primary patency, and complications at 1 year with higher expense associated with the use of clips. Thus, in an effort to reduce the economic burden of healthcare in the United States, the findings from the present study support the preferential use of the standard polypropylene suture technique when creating upper extremity AVFs.
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Affiliation(s)
- Samantha Terranella
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill.
| | - Marie Fefferman
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill
| | - Yanyu Zhang
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, Ill
| | - Kathleen Wright
- Financial Planning and Decision Support, Rush University Medical Center, Chicago, Ill
| | - Edward Hollinger
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill
| | - Oyedolamu Olaitan
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill
| | - Martin Hertl
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill
| | - Stephen Jensik
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill
| | - Richard Keen
- Department of Surgery, John H. Stroger Hospital of Cook County, Chicago, Ill
| | - Edie Chan
- Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill
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Saad H, Krisht KM, Yang WH, Aboud E, Krisht AF. Rapid M1 Hemoclips Arteriotomy Repair After Emergency Coil Embolectomy. Oper Neurosurg (Hagerstown) 2018. [DOI: 10.1093/ons/opx187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The vascular closure staple clips have been studied in animal models and shown to have comparable results with sutured repair when it comes to the healing process, degree of vessel narrowing, and risk of thrombosis. However, they are clearly superior when the speed of application is taken into account, and they were clinically used in many vascular repair processes. Nevertheless, their usefulness in intracranial vascular surgery has not been described.
OBJECTIVE
To describe the usefulness of hemoclips in fast and efficient repair of medium-sized and large intracranial vessels.
METHODS
Two female patients diagnosed with giant symptomatic cavernous sinus aneurysms were undergoing elective endovascular procedures that were complicated by the dislodgement of coils into the M1 segment of the middle cerebral artery. Both patients were treated performing M1 arteriotomies and coil embolectomy. To avoid prolonged temporary occlusion in the M1 perforator's territory, the arteriotomies were repaired using microhemoclips in less than 10 min with re-establishment of flow.
RESULTS
In both patients, flow was re-established in the M1 segments. In 1 patient, the coils extended to the temporal M2 causing intimal injury and leading to diminished flow. M1 segments in both patients were patent on later angiographic studies.
CONCLUSION
We describe the advantage of emergent cerebrovascular arteriotomy and embolectomy in a rapid repair process that helped avoid massive ischemic injury. We believe this technique should be added to the armamentarium of neurosurgical cerebrovascular options.
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Affiliation(s)
- Hassan Saad
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
| | - Khaled M Krisht
- Department of Neurosurgery, Baptist Health, Montgomery, Alabama
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Wei-hsun Yang
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi Center, Putz, Taiwan
| | - Emad Aboud
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
| | - Ali F Krisht
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
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Thorpe E, Patil Y. Mechanical venous anastomosis in head and neck microvascular reconstruction as an equivalent to the gold standard. EAR, NOSE & THROAT JOURNAL 2017; 96:E32-E36. [PMID: 28231374 DOI: 10.1177/014556131709600217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To define the most successful and efficient manner to perform venous microvascular anastomoses, the effectiveness of mechanical venous anastomosis in head and neck microvascular reconstruction is reviewed. Head and neck reconstruction with free flap techniques has become the norm and gold standard for large defects. This retrospective, multicenter case series of a single microvascular surgeon's experience with mechanical venous anastomoses specifically assessed the effectiveness of head and neck reconstruction and the complications associated with it. Data were collected from two separate academic centers and are reported from a consecutive series of patients over the course of 10 years. All patients underwent microvascular reconstruction of the head and neck region using venous couplers and flap survival. Flap survival was greater than 98% using mechanical venous couplers as the primary means for venous outflow in this series of 402 consecutive patients and 431 total microvascular flaps. Venous couplers were performed in every instance. The study shows that mechanical venous anastomosis provides a highly effective and efficient means for venous outflow in head and neck microvascular reconstruction, and should be considered equivalent to the gold standard suture technique, even in the most difficult cases.
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Affiliation(s)
- Eric Thorpe
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) Neuroscience Institute, UC Academic Health Center, Cincinnati, OH 45267, USA
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Freire LMD, Gobbi GB, Dal Fabbro IM, Menezes FH. Experimental Model for Sutureless Proximal Anastomosis by the Viabahn Open Revascularization TEChnique (VORTEC). Braz J Cardiovasc Surg 2017; 31:440-443. [PMID: 28076621 PMCID: PMC5407145 DOI: 10.5935/1678-9741.20160087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/19/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction In the treatment of complex aneurysms, debranching is an extra-anatomical revascularization of visceral arteries followed by endograft coverage of the thoracoabdominal aorta. It eliminates the need for a thoracotomy and aortic clamping, but requires the performance of several technically demanding visceral anastomosis. In 2008, Lachat described visceral revascularization with the use of a sutureless distal anastomosis, performed by the telescoping of an endograft in the visceral branch, named VORTEC (Viabahn Open Revascularization TEChnique). Objective An experimental model was created to test the feasibility and short term results of performing a telescoped proximal anastomosis to the abdominal aorta. Methods Swine model. The abdominal aorta was dissected and ligated between the renal arteries and the iliac vessels. Three centimeters bellow the renal arteries a Viabahn endograft was telescoped for 2 cm into the proximal aorta. The other extremity was conventionally anastomosed to the distal aorta. Patency, sealing and tensile strength of the anastomosis were tested. Results Time for performing the telescoped anastomosis was shorter (5.4±2.8 min versus 10.3±3.4 min, P<0.05). All grafts were patent and both types of anastomosis presented no bleeding. Immediate tensile strength showed a higher strength of the conventional suture (22.7 x 14.3 N, P<0.09). After 30 days there was no pseudo-aneurysms and the strength of the conventional and VORTEC anastomosis were similar (37.3 x 40.8 N, respectively, P=0.17). Conclusion Telescoped proximal anastomosis by the technique of VORTEC is feasible. After 30 days the tensile strength of the both anastomosis were similar.
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Affiliation(s)
- Lucas Marcelo Dias Freire
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | | | - Inácio Maria Dal Fabbro
- Faculdade de Engenharia Agrícola da Universidade Estadual de Campinas (FEA- GRI-UNICAMP), Campinas, SP, Brazil
| | - Fábio Hüsemann Menezes
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas, SP, Brazil
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Smeets R, Vorwig O, Wöltje M, Gaudin R, Luebke AM, Beck-Broichsitter B, Rheinnecker M, Heiland M, Grupp K, Gröbe A, Hanken H. Microvascular stent anastomosis using N-fibroin stents: feasibility, ischemia time, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e97-e103. [DOI: 10.1016/j.oooo.2016.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
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Comparison of Nonpenetrating Titanium Clips versus Continuous Polypropylene Suture in Dialysis Access Creation. Ann Vasc Surg 2016; 32:15-9. [DOI: 10.1016/j.avsg.2015.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022]
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Aitken E, Jeans E, Aitken M, Kingsmore D. A randomized controlled trial of interrupted versus continuous suturing techniques for radiocephalic fistulas. J Vasc Surg 2015; 62:1575-82. [DOI: 10.1016/j.jvs.2015.07.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
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8
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Li R, Lan B, Zhu T, Yang Y, Wang M, Ma C, Chen S. Establishment of an animal model of vascular restenosis with bilateral carotid artery grafting. Med Sci Monit 2014; 20:2846-54. [PMID: 25549796 PMCID: PMC4286978 DOI: 10.12659/msm.891303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Vascular restenosis occurring after CABG is a major clinical problem that needs to be addressed. Vein grafts are associated with a higher degree of stenosis than artery grafts. However, the mechanism responsible for this effect has not been elucidated. We aimed to establish a rabbit model of vascular restenosis after bilateral carotid artery grafting, and to investigate the associated spatiotemporal changes of intimal hyperplasia in carotid artery and jugular vein grafts after surgery. Material/Methods Twenty adult New Zealand white rabbits (10 males; 10 females), weighing 2.0–2.5 kg, were obtained from the Experimental Animal Center of Southern Medical University, Guangzhou, China (License No.: scxk-Guangdong-2006-0015). We quantitatively analyzed intimal thickness, area, and degree of stenosis in carotid artery and jugular vein bridges. Results After 8 weeks of a high-fat diet, rabbit carotid arteries showed early atherosclerotic lesions. With increasing time after surgery, carotid artery and jugular vein grafts showed histopathological and morphological changes, including smooth muscle cell migration, lipid deposition, intimal hyperplasia, and vascular stenosis. The degree of vascular stenosis was significantly higher in vein grafts than in artery grafts at all time points – 35.1±6.7% vs. 16.1±2.6% at Week 12, 56.2±8.5% vs. 23.4±3.4% at Week 16, and 71.2±1.3% vs. 25.2±5.3% at Week 20. Conclusions Rabbit bilateral carotid arteries were grafted with carotid artery and jugular vein bridges to simulate pathophysiological processes that occur in people after CABG surgery.
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Affiliation(s)
- Ruixiong Li
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
| | - Bin Lan
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
| | - Tianxiang Zhu
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
| | - Yanlong Yang
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
| | - Muting Wang
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
| | - Chensheng Ma
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
| | - Shu Chen
- Department of Cardiac-Thoracic Surgery, Shantou Central Hospital / Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China (mainland)
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9
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Anastomoses in the Common Femoral Artery, Vascular Clips or Sutures? A Feasibility Study. Ann Vasc Surg 2013; 27:194-8. [DOI: 10.1016/j.avsg.2012.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 02/10/2012] [Accepted: 02/10/2012] [Indexed: 11/22/2022]
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10
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Yuan XP, Gao W, Jiao WH, Wang CX. Kidney transplantation in diabetic recipients with iliac atherosclerosis: Arterial anastomosis with Nakayama's ring pin stapler after endarterectomy. Int J Urol 2011; 19:336-42. [DOI: 10.1111/j.1442-2042.2011.02934.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Pratt GF, Rozen WM, Westwood A, Hancock A, Chubb D, Ashton MW, Whitaker IS. Technology-assisted and sutureless microvascular anastomoses: evidence for current techniques. Microsurgery 2011; 32:68-76. [PMID: 22121054 DOI: 10.1002/micr.20930] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/12/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting their use. METHODS Techniques of microvascular anastomosis were investigated by performing searches of the online databases Medline and Pubmed. Returned results were assessed according to the criteria for ranking medical evidence advocated by the Oxford Centre for Evidence Based Medicine. Emphasis was placed on publications with quantifiable endpoints such as unplanned return to theatre, flap salvage, and complication rates. RESULTS There is a relative paucity of high-level evidence supporting any form of assisted microvascular anastomosis. Specifically, there are no randomized prospective trials comparing outcomes using one method versus any other. However, comparative retrospective cohort studies do exist and have demonstrated convincing advantages of certain techniques. In particular, the Unilink™/3M™ coupler and the Autosuture™ Vessel Closure System® (VCS®) clip applicator have been shown to have level 2b evidence supporting their use, meaning that the body of evidence achieves a level of comparative cohort studies. CONCLUSION Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/3M™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-Clip®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques.
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Affiliation(s)
- George F Pratt
- Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne, Melbourne, Vic., Australia
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Pratt GF, Rozen WM, Chubb D, Whitaker IS, Grinsell D, Ashton MW, Acosta R. Modern adjuncts and technologies in microsurgery: An historical and evidence-based review. Microsurgery 2010; 30:657-66. [DOI: 10.1002/micr.20809] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/13/2010] [Indexed: 11/11/2022]
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Zhou F, Fang ZQ, Zhang YN, Chen W, Liu YL, Ye G. Suture-free technique of extravesical ureteroneocystostomy with ring pin stapler: experimental study of canines. I. Preliminary results. Urology 2010; 76:500-6. [PMID: 20451973 DOI: 10.1016/j.urology.2010.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/05/2010] [Accepted: 01/15/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the mechanical and sutured ureteroneocystostomy in a canine model. METHODS In 18 dogs, extravesical ureteroneocystostomy on 1 side was randomly assigned to end-to-side anastomosis performed with a titanium ring-pin stapler or interrupted absorbable sutures. To create the antireflux tunnel, the longitudinal line of the muscle layer was closed over the implanted ureter with titanium clips or sutures. At 3 months postoperatively, renal ultrasonography, intravenous urography, ascending cystography, the Whitaker test, and the macroscopic and microscopic results were assessed. RESULTS The ureteroneocystostomy with the ring pin stapler and the antireflux tunnel construction with titanium clips had a 100% technical success rate. Compared with manual suturing anastomosis, the suture-free technique took a significantly shorter time and resulted in slightly, but not significantly, less ureteral obstruction after 3 months. One dog in group 2 had evidence of ureteral dilation and hydronephrosis compared with the normal contralateral side. No signs of stone formation, urinary cyst, or fistulas were found after either closure method. None of the 18 dogs demonstrated vesicoureteral reflux. Histologic examination showed no signs of acute inflammation or marked fibrosis in any of the 18 specimens. Moreover, the intrapelvic pressure in group 1 was approximately similar to that of the normal contralateral side. CONCLUSIONS Ureteroneocystostomy performed with a titanium ring-pin stapler is feasible and faster than using conventional sutures. This suture-free technique is simple and safe, with possibly lower complication rates than a nonstented suture technique. Additional studies with a longer follow-up duration are needed to confirm these results.
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Affiliation(s)
- Feng Zhou
- Department of Urology, Center of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Ueda K, Mukai T, Ichinose S, Koyama Y, Takakuda K. Bioabsorbable device for small-caliber vessel anastomosis. Microsurgery 2010; 30:494-501. [DOI: 10.1002/micr.20764] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Romani R, Kivisaari R, Çelik Ö, Niemelä M, Perra G, Hernesniemi J. REPAIR OF AN ALARMING INTRAOPERATIVE INTRACAVERNOUS CAROTID ARTERY TEAR WITH ANASTOCLIPS: TECHNICAL CASE REPORT. Neurosurgery 2009; 65:E998-9; discussion E999. [DOI: 10.1227/01.neu.0000350877.43579.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Surgical treatment of an intracavernous carotid aneurysm (ICCA) is difficult because of the close relationship to bone, dura, and neurovascular structures. Intraoperative rupture of an ICCA is challenging, especially if the site of rupture is at the base of the aneurysm. We present a case of intraoperative rupture of an ICCA caused by clinoidectomy. We repaired it by using a single-clamp applicator (AnastoClip Vessel Closure System, 1.4 mm; LeMaitre Vascular, Burlington, MA).
CLINICAL PRESENTATION
In April 2007, a 40-year-old woman underwent neurosurgical treatment at another institution for a ruptured basilar bifurcation aneurysm, with good recovery. Digital subtraction angiography performed at this time showed the presence of left internal carotid artery aneurysms, 1 at the anterior wall of the paraclinoidal segment and 1 at the lateral wall of the intracavernous segment. In February 2008, the patient was referred from outside Finland to our department for microsurgical treatment of both aneurysms.
TECHNIQUE
A lateral supraorbital approach was used, and during extradural removal of the anterior clinoid with a rongeur, the ICCA ruptured. The base of the intracavernous aneurysm was involved in the rupture, and we used a single-clamp applicator to repair the internal carotid artery. Intraoperative digital subtraction angiography, indocyanine green video angiography, and Doppler ultrasonography showed a good flow in the artery. The paraclinoid aneurysm was uneventfully clipped during the same intervention.
CONCLUSION
Intraoperative rupture of ICCA was repaired quickly and effectively by using a single-clamp applicator. Our case and experimental data from other microsurgical vascular experiences suggest that the future of intracranial vessel repair/anastomoses will be using microclips and other simpler devices more, allowing the neurosurgeon to perform fast and effective vessel repair.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Özgür Çelik
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Giancarlo Perra
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Masuda S, Saiki Y, Kawatsu S, Yoshioka I, Fujiwara H, Kawamoto S, Sai S, Iguchi A, Sakamoto N, Ohashi T, Sato M, Tabayashi K. Trial of new vascular clips for aortic anastomosis in a canine model. J Thorac Cardiovasc Surg 2007; 134:723-30. [PMID: 17723824 DOI: 10.1016/j.jtcvs.2007.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 04/18/2007] [Accepted: 04/23/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We created a new vascular clip designed for aortic surgery. The purposes of this investigation were to examine surgical applicability in a clinically relevant aortic replacement model and to assess biomechanical strength of the clipped anastomosis and serial histologic changes in the clipped anastomotic site. METHODS Twenty-one beagles underwent descending thoracic aortic replacement. Distal anastomosis was performed with the new clips, mimicking the cuffed anastomosis technique, and proximal anastomosis was carried out by conventional suture anastomosis. Tissue specimens of the anastomotic sites were harvested at 1, 3, 6, and 12 months postoperatively for examination. RESULTS There was no significant difference in the time required to carry out clip anastomosis (12.2 +/- 1.3 minutes) and suture anastomosis (13.7 +/- 0.9 minutes; P = .38). Neither type of anastomotic site was disrupted by raising the intraluminal pressure to 280 mm Hg. Microscopically, the areas of aortic wall compressed by vascular clips appeared as hyalinized areas adjacent to surrounding collagen fibers, with no significant infiltration of inflammatory cells. Identical histologic changes were observed at the site of the sutured anastomosis. The media at the clipped anastomosis site was significantly thinner than that at the sutured anastomosis site at 1 month after the operation. However, there was no significant difference in the thickness of the media at 3 months. CONCLUSIONS The new vascular clips were effective in this clinically relevant model, with appropriate biomechanical strength, and the anastomotic sites underwent similar histologic changes to those observed after suture anastomosis.
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Affiliation(s)
- Shinya Masuda
- Department of Cardiovascular Surgery, Tohoku University, Sendai, Japan.
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Ye G, Mo HG, Wang ZH, Yi SH, Wang XW, Zhang YF. Arterial Anastomosis Without Sutures Using Ring Pin Stapler for Clinical Renal Transplantation: Comparison With Suture Anastomosis. J Urol 2006; 175:636-40; discussion 640. [PMID: 16407013 DOI: 10.1016/s0022-5347(05)00143-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The metal ring pin stapler was initially developed for microvascular surgery and there has been little experience of their use in larger vessels. We determined if the titanium ring pin coupling system could be safely and rapidly applied for arterial reconstruction in clinical renal transplantation. MATERIALS AND METHODS The donor renal artery was end-to-end anastomosed to the internal iliac artery with titanium ring pin staplers in 36 patients. Anastomotic, clamp and total operative time and vascular problems were compared with those in the control group of sutured anastomosis in 39 transplant recipients. RESULTS The completion of mechanical anastomosis required half the time of suture anastomosis. Mean clamp time was 17.8 minutes in the nonsuture group and 28.1 minutes in the control group. There was no significant difference in total operative time between the 2 groups. A small anastomotic line leak was noted in each group, which was temporary and self-limited. There were no postoperative anastomotic failures, postoperative bleeding episodes or need to revise the anastomosis (100% patency rate) in the 2 groups. Of the patients 61 were followed for 2 to 5 years. Transplant renal artery stenosis was observed in 1 patient in the nonsuture group but 3 in the control group. CONCLUSIONS The anastomotic technique with the ring pin system is safe and simple, permitting an expeditious and everting anastomosis with a smooth intima-to-intima junction. Application of this technique may decrease warm ischemia time and the incidence of anastomotic artery stenosis, thus, improving outcomes.
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Affiliation(s)
- Gang Ye
- Department of Urology, Center of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China.
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Hermiller JB, Simonton C, Hinohara T, Lee D, Cannon L, Mooney M, O'Shaughnessy C, Carlson H, Fortuna R, Zapien M, Fletcher DR, DiDonato K, Chou TM. The StarClose® vascular closure system: Interventional results from the CLIP study. Catheter Cardiovasc Interv 2006; 68:677-83. [PMID: 17039508 DOI: 10.1002/ccd.20922] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The StarClose Vascular Closure System is a femoral access site closure technology that uses a flexible nitinol clip to complete a circumferential, extravascular arteriotomy close. The Clip CLosure In Percutaneous Procedures study was initiated to study the safety and efficacy of the StarClose device in subjects undergoing diagnostic and interventional catheterization procedures. METHODS A total of 17 U.S. sites enrolled 596 subjects, with 483 subjects randomized at a 2:1 ratio to receive StarClose or standard compression of the arteriotomy after the percutaneous procedure. The study included roll-in (n = 113), diagnostic (n = 208), and interventional (n = 275) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis. RESULTS The results of the diagnostic StarClose cohort have been reported separately. Results for the interventional arm revealed major vascular complications occurring in 1.1% of StarClose subjects (2/184) and 1.1% in manual compression subjects (1/91; P = 1.00). No infections were seen in either cohort. Minor complications in the StarClose interventional group occurred at a rate of 4.3% (8/184) and with compression at 9.9% (9/91; P = 0.107). Pseudoaneurysm or arteriovenous fistula was not seen with StarClose. With StarClose, procedural success was 100% (136/136) for the diagnostic group and 98.9% (181/183) in the interventional group. Device success for the treatment group was 86.8%. In the interventional cohort, 87.3% (158/181) of StarClose subjects reported a pain scale of 0-3 compared with 93.3% (84/90) in the compression group, which was not statistically different. CONCLUSIONS The clinical results of this study demonstrate that the StarClose Vascular Closure System is noninferior to manual compression with respect to the primary safety endpoint of major vascular events in subjects who undergo percutaneous interventional procedures. StarClose significantly reduced time to hemostasis, ambulation, and dischargeability when compared with compression.
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Schild F. Pro/Con Interrupted Clips or Sutures, Which is the Best Solution?: Interrupted Clips Give a Better Outcome. J Vasc Access 2005. [DOI: 10.1177/112972980500600334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- F. Schild
- Miller School of Medicine, University of Miami, Miami FL - USA
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Zeebregts CJ, van den Dungen JJAM, van Det RJ, Verhoeven ELG, Geelkerken RH, van Schilfgaarde R. Randomized clinical trial of continuous sutures or non-penetrating clips for radiocephalic arteriovenous fistula. Br J Surg 2004; 91:1438-42. [PMID: 15386322 DOI: 10.1002/bjs.4719] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Despite several modifications to the original design, patency rates of radiocephalic arteriovenous fistulas have changed little since the first report in 1966. The use of non-penetrating clips for vascular anastomosis on the outcome of such fistulas was studied.
Methods
Between January 2000 and August 2003, 107 primary radiocephalic fistulas were constructed in 98 patients. The vascular anastomoses were performed at random with either sutures (n = 56) or clips (n = 51).
Results
Although there were trends for better primary and primary assisted patency of clipped fistulas, the differences were not statistically significant. The 6-month primary patency rate was 61 per cent with sutures and 69 per cent with clips (P = 0·393). The mean(s.d.) primary patency was 315(306) and 285(285) days for clipped and sutured fistulas respectively. With regard to secondary patency, clipped fistulas were better (P = 0·009). The mean(s.d.) secondary patency was 435(376) and 344(316) days for clipped and sutured fistulas, respectively. There were no significant differences in flow characteristics, number of revisions or other morbidity.
Conclusion
This randomized clinical trial provided further evidence that the use of vascular clips may improve the patency rate of radiocephalic arteriovenous fistulas for haemodialysis.
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Affiliation(s)
- C J Zeebregts
- Department of Surgery, University Hospital Groningen, Groningen, The Netherlands.
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