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In Reply.—One would agree that "crushing the vein that is being prepared for angioaccess" is "an affront to the technical knowledge and common sense of vascular surgeons." However, the bulldog clamp shown in the article was designed to avoid such trauma. It is a springloaded clamp with a thumb screw that can be adjusted to apply minimal pressure. Unfortunately, the adjusting screw was not shown in the illustration, admittedly an oversight.
We have not had any problems of early or late stenosis with the described method and have been able to maintain several fistulas that were originally of questionable size.
MINDICH BP. Enhancement of Flow Through Arteriovenous Fistula-Reply. Arch Surg. 1976;111(7):831. doi:10.1001/archsurg.1976.01360250107027