Vascular anastomosis

The union of blood vessels must be carried out not by inversion but by eversion, in order to bring into apposition the inner endothelial layers. If this is not done, clots form at the anastomosis and block the lumen. Classically, the ends of vessels are first united by three stay sutures that divide the circumference into thirds (Fig. 6.12) . A running stitch of fine (metric 0.7-0.4) monofilament polyamide or polypropylene suture is then carried round the circumference of the stoma (Fig. 6.13).

Very small vessels can be united but this requires an entirely different technique. The anastomosis is carried out using very fine instruments and the procedure is performed using an operating microscope. It is not possible to evert the vessels; instead, the anastomosis is formed using a series of interrupted sutures bringing the ends together, edge-to-edge.

Figure 6.13. Everted edges in vascular anastomosis to bring the inner, endothelial surfaces into contact.
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