Local surgeon finds different way in for dialysis

Local surgeon finds different way in for dialysis

By Jennifer Lord/MetroWest Daily News staff
Framingham, MA

Fri May 04, 2007, 11:36 PM EDT

Dr. Arnold Miller works best with an audience.

Broadcasting live from the operating room via a camera on his head, Miller made an incision in the forearm of his patient, working down through the layers of skin and tissue to reach veins and arteries.

On the menu for the day: a procedure called anastomosis, which connects an artery directly into a vein, creating an access site for dialysis called an arteriovenous fistula. It's a fairly common surgery, but what drew a crowd of doctors to MetroWest Medical Center's Leonard Morse campus yesterday was the unusual tools of Miller's trade.

Rather than use sutures, Miller uses a closure system, the AnastoClip VCS, which uses tiny clips to stick the vessels together. The vascular surgeon is considered one of the country's top experts in the cutting-edge procedure and LeMaitre Vascular, the Burlington-based device maker, periodically flies in surgeons from around the world to watch Miller at work.

"The clips are more expensive than sutures, but they're ultimately less expensive because they are a better treatment," Miller said. "The clips are non-penetrative. There isn't the clotting or inflammation that is associated with sutures. Anyone who is on dialysis today has three dialysis a week, which is a hell of a lot, and this reduces the stress."

Dialysis is the primary treatment for renal failure, when a patient's kidneys are unable to clean wastes from their blood. Nearly 500,000 Americans are undergoing dialysis, according to the National Institutes of Health, most due to diabetes or hypertension.

The clip system was created by Dr. Wolff Kirsh of Loma Linda University Medical Center in California. Kirsh, with whom Miller has co-authored journal studies, based the clips on the pinchers of the African army ant, which have been used through history to close wounds. Rather than rely on decapitated ants, Kirsh developed a tiny titanium clip, ranging in size from .9 mm to 3 mm, and a forceps delivery system.

Miller has been using the system since 1996 and generally leads three classes a year, usually at Leonard Morse. He is occasionally flown by LeMaitre to other sites to provide guidance to doctors considering the technology.

Magnified on a large screen in the hospital's Helm Auditorium, the veins of Miller's patient resembled large rain-engorged worms. The actual incision site was just a little larger than the tip of Miller's index finger.

Miller gently used yellow loops to bring the necessary vein and artery to the surface and, conferring with the doctors in the auditorium via microphone, made incisions in each. Overlapping the incisions, he quickly closed them with the clips, creating nearly a full circle of silvery hoops.

"It takes a while to set up your anastomosis, but it's really quick when you get to the clips. And you sing the song - 'no lips, no clips,"' he said, referring to the overlapping of the vessels. He laughed as his patient, who remained conscious throughout the outpatient procedure, repeated the motto. "He's singing it with me - no lips, no clips."

Miller performed two surgeries before the doctors, answering and posing questions throughout to his remote audience.

(Contact Jennifer Lord at 508-626-3880 or jlord@cnc.com)

Here's the youtube video accomanying the article http://www.youtube.com/watch?v=ZoxQiNz_cyY&eurl=http%3A%2F%2Fwww%2Emetrowestdailynews%2Ecom%2Fhomepage%2Fx1404704757