Vascular Clips in the Creation of Arteriovenous Fistula for Hemodialysis

Yu, Hee Chul; Lee, Tae Hoon; Jeong, Yeon Jun; Cho, Baik Hwan

Abstract

PURPOSE: A vascular clipping system (VCS) has been introduced for clinical use. This study was developed to compare the VCS with prolene for anastomosis of arteriovenous fistula (AVF) in hemodialysis access surgery.
METHODS
127 consecutive patients requring autologous AVF for hemodialysis and divided into two treatment groups (VCS:Prolene) by their anastomosis methods. Anastomoses were constructed with the VCS in 44 patients and with hand-swen prolene suturing in 83 patients. Among them 35 clipped and 71 sutured were able to follow up survery and the patency rates were analysed by log-rank test.
RESULTS
In the VCS cases, end to side AV anastomosis was applied and mean diameter of artery and vein was 1.7 mm, and vein was able to extend to 2.9 mm averagely. The average size of anastomosis length was 7.8 mm. Operation time was 51 (40~120) minutes and the average anastomosis time was 6.5 (3~15) minutes. The average use of clip was 12. In the prolene cases, 28 cases of end to side anastomosis were measured for diameter and the average diameter was 1.7 mm in artery and 1.9 mm in vein, and the average extension of vein was 2.8 mm. Operation time was 76.5 (40~160) minutes and the average anastomosis time was 10~15 minutes. In 55 cases of side to side anastomosis, the average size of anastomosis length was 19.2 mm. There was no other complication after operation except for each one case of received hematoma remove. In the survey cases (VCS : prolene - 35 :71), early failures were 3 :8 cases (8.6 :11.3%), late failures 5 :16 cases (14.3 :22.5%) as the result of 11.3 :12.0 months in average observation. The causes were 3 :5 cases in functional failure, 5 :17 cases in thrombosis and stricture, the other causes were 2 cases in prolene. The cumulative secondary patency rate was 88.3 :65.9% (31 :47 cases). There was higher patency in VCS, but there was no significant difference in the primary and second patency rates in log-rank analysis.
CONCLUSION
VCS clip could be able to shorten the clamping time of blood vessel by reducing anastomosis time. Although there was no statistically significant difference between the VCS clips and prolene sutures, the AVF formation with VCS reduced failure rate and improved patency rate.