Creation of Native Arteriovenous Fistulas with Interrupted Anastomoses Using a Self-Closing Clip Device - One Clinic's Experience

The nitinol U-CLIPTM Anastomotic Device (Coalescent Surgical, Inc., Sunnyvale, CA) is a self-closing penetrating vascular clip that reduces suture management and eliminates knot tying, thus enabling rapid and precise interrupted suture placement and facilitating creation of an optimal vascular anastomosis. This report describes the use of U-CLIP devices in the surgical creation of native arteriovenous fistulas in 68 chronic hemodialysis patients. Overall, 61 of the 65 fistulas created matured successfully within 8-9 weeks. Radial cephalic fistulas: 93% were mature at 8 weeks. Brachiocephalic fistulas: 69% were mature at 8 weeks. One-stage basilic vein transposition: 100% were mature at 9 weeks. Two-stage basilic vein transposition: 100% were mature at 8 weeks after second stage. The results in this report show the excellent performance of U-CLIP vascular clips in the creation of several types of native arteriovenous fistulas in chronic hemodialysis patients. The fistulas created using the U-CLIP devices had a high maturation rate within a relatively short time period, and provided uniformly high flow rates. The patients in this study were a challenging population, with a high incidence of diabetes mellitus (81% of the patients) and vein sizes that were smaller than typically used for fistula creation. The U-CLIPTM Anastomotic Device offers the opportunity to create superior interrupted anastomoses for AV fistulas, even in patients who would otherwise be considered poor candidates for fistula creation.