In search of the “perfect” anastomosis

Abstract

Forty-five end-to-side microvascular anastomoses were completed in rat carotid arteries of 0.7-0.8 mm diameter (anastomosing the distal end of the left common carotid to the side of the right common carotid). For comparison both 10-0 and 11-0 sutures were utilized in different anastomotic techniques: interrupted, direct-continuous, and diagonal-continuous sutures, plus total mural thickness vs. partial mural thickness (piercing only the adventitia and outer media, excluding the intima). Anastomoses were evaluated for patency and scanning electron microscopic appearance after 10 to 12 weeks. The results indicate complete patency in all anastomoses. Ultrastructural observations revealed nearly normal intimal appearance in the partial medial technique and only minimal evidence of intimal injury in the other techniques. It is concluded that 100% patency can be obtained regardless of suture size or anastomotic technique. The most important factor in anastomotic patency is the operator's technical skill.

Small bowel transplantation in rats, A multicenter experience summarizing the pitfalls to be overcome

“…A successful vascular anastomosis is achieved following the microsurgery principles recommended by Guity et al [24]. Despite hand-sewn sutures remains the most widely use, alternative methods to reduce complications associated with vascular anastomosis such as the 3-cuff technique was developed and published [12].…”

Modèle animal d'entraînement à l'anastomose temporosylvienne

“…Un modèle similaire utilisant un crâne moulé est également retrouvé dans la littérature, proposant une voie d'abord sylvienne mais ne décrivant pas de geste anastomotique spéci-fique comme décrit ici (Menovsky, 2000). Du point de vue de la technique d'anastomose, des études sur les artères carotides communes du rat ont prouvé que le type de suture effectuée (terminoterminal versus terminolatéral, fils 10/0 versus 11/0, points séparés versus surjet) ne modifiait pas le pronostic de la perméabilité et que le facteur déterminant était l'habileté de l'opérateur, donc son entraînement (Calvo et Purriel, 1980 ;Dotson et al, 1998 ;Guity et al, 1990 ;Mao et al, 1986). Des complications rares telle une thrombose des vaisseaux anastomosés, plus rarement une embolie dans le nouveau vaisseau (Takeuchi et al, 1995) ou le développement d'un anévrisme pouvant se rompre au niveau des sutures (Kohno et al, 1996) sont également décrits.…”

End‐to‐end versus end‐to‐side arterial anastomosis patency in microvascular surgery

“…Other factors may dictate which anastomosis is utilized clinically, including the availability of an expendable vessel for an end-toend anastomosis. Surgical technique is likely a major factor in patency, 17 but the decision to perform an end-to-end vs. an end-to-side arterial anastomosis should be based upon the clinical circumstances encountered, since no significant difference in patency rates exists between the two methods.…”