Creating arteriovenous fistula using an automatic anastomotic device

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Creating arteriovenous fistula using an automatic anastomotic device Michalis Argiriou, MD, Ioannis Paralikas, MD, Vania Anagnostakou, MD, Victor Panagiotakopoulos, MD, Orestis Argiriou, MD, Christos Charitos, MD Journal of Vascular Surgery Volume 53, Issue 2, Pages 531-533 (February 2011) DOI: 10.1016/j.jvs.2010.08.008 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 The C-Port system: image on the left shows the parts of the C-Port system, (A) shaft, (B) trigger, (C) activation knob, and (D) head of the device (can be rotated in the plane of the shaft). The image on the right is a schematic depicting the loading technique. Panels (A) and (C) show the anvil (1), heel clip (2), cartridges (3), the piercer (4), the shield (5), and the clamp (6). In panel (A) the distal end of the graft that will be located at the heel of the anastomosis is shown. An incision long enough to allow the distal end of the graft to cover the entire cartridge surface area is created. The shield (5) is flipped outward so that the tip of the shield is facing away from the cartridge. The piercer (4) is rotated upward until it stops. This action will expose the tip of the heel clip. In panels (B) and (C), forceps are used to advance the graft, incised edge first, between the cartridge arms (3). This action can be facilitated by using a second forceps to grasp the graft on the underside of the cartridge while sliding in between the arms. With the aid of the forceps, the two flaps of the graft are grasped at the base of the incision and held above the tine of the heel clip (2). In panels (D) and (E), the conduit is held in position as the left graft clamp is lowered with the piercer (4) until it has fully pierced the conduit on the heel clip (2). Once the graft is aligned and the graft tissue completely covers the full length of both loading platforms, the left graft clamps are lifted to the upper-most position and the piercer is slid forward to detach. The two graft clamps are then lowered (6). The C-Port system is ready for the target vessel anastomosis. Journal of Vascular Surgery 2011 53, 531-533DOI: (10.1016/j.jvs.2010.08.008) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 The image on the left shows computer images of the C-Port system deployment sequence. A, A small opening (1 mm) in the target vessel is created (asterisk). B, The anvil is inserted into target vessel. The graft is preloaded onto the cartridge. C, The deployment trigger is actuated and the cartridge is closed (arrow). D, Top view of the closed cartridge with staples being deployed. The staples are deployed through the graft and target vessel and form against anvil surfaces. Panels (E) and (F) simultaneously show an arteriotomy knife (asterisk) inside the anvil that creates an opening in the target vessel from the inside out. G, The actuation trigger is released and the cartridge opens (arrow). H, The anvil is removed from target vessel, and the anvil insertion hole is closed with a separate stitch (arrow). The image on the right shows a surgical image of the radio-cephalic fistula after completion with the Cardica C-Port System. Journal of Vascular Surgery 2011 53, 531-533DOI: (10.1016/j.jvs.2010.08.008) Copyright © 2011 Society for Vascular Surgery Terms and Conditions