Technical considerations in the construction of vascular anastomoses

Over the past several years, great strides have been made with respect to the way many surgeons construct vascular anastomoses. The word “anastomosis�? comes from a Greek word meaning outlet and also comes from the Latin root word anastomoun which means to furnish with a mouth. The definition of anastomosis is the surgical connection of separate or severed tubular hollow organs to form a continuous channel, as between two parts of an artery or a vein. Vascular anastomoses of some kind are used in many of the surgical subspecialties. Vascular surgeons perform procedures such as arterial to venous bypass grafts for hemodialysis, and arterial bypass grafts for arterial insufficiency. Cardiac surgeons perform coronary artery bypass grafting as a means to revascularize the heart. They use autologous saphenous vein grafts and bypass blood directly from the aorta to the major vessels of the heart (e.g., left anterior descending, and the circumflex artery). Other fields in which vascular and microvascular anastomoses are used include otolaryngology, plastic surgery, neurosurgery, and pediatric surgery. The field of transplantation surgery routinely utilizes the concept of anastomoses. The organs harvested from the cadaver must include vessels that are long enough to be anastomosed to the recipient vessels. Additionally, it is important to realize that other structures such as the common bile duct in liver transplantation, the small bowel in small bowel transplantation, and the ureters in renal transplantation are tubular structures which require coaptation via suture anastomosis.