Carotid arteriotomy closure using a vascular clip system

PURPOSE: To compare a newly released vascular clip system (Vascular Clip-applier System; Auto Suture Company, Norwalk, CT) designed for sutureless vessel closures and anastomoses with standard suture closure of carotid arteriotomies after carotid endarterectomies. PATIENTS AND METHODS: Sixteen consecutive patients with symptomatic and severe carotid stenoses were randomly allocated to receive either standard suture (running 6-0 monofilament) or clip artery closures after undergoing carotid endarterectomies. The speed of arteriotomy closure was calculated for each procedure, and hemostasis, complications, and postoperative carotid patency were determined and recorded for each patient. RESULTS: The clip applier system performed well, and arteriotomy closure with clips was significantly faster than suture closure (0.36 cm/min in the sutured group versus 0.52 cm/min in the clipped group, P = 0.019). Carotid patency assessed by ultrasonography 4 to 8 weeks after surgery showed that all arteries in both groups were patent. Two hemostasis problems occurred in the clip closure group, one minor that was caused by the use of incorrect clip size and one major that was probably caused by a combination of sudden arterial hypertension and clip failure. This complication resulted in a large neck hematoma and cross-clamp ischemia during the ensuing suture repair of the arterial dehiscence. CONCLUSIONS: As a result of this small study, we determined that clip closure of carotid arteriotomies was feasible, but it remains questionable whether the increased speed of a sutureless closure is clinically important for this procedure. Concerns regarding the strength of clip closure of an endarterectomized vessel and the cost of clip closure compared with standard suture techniques suggest that there may be no clinically significant benefits of arterial clip closure over suture closure after carotid endarterectomy, and there is potentially some risk.