Alternative Approaches to Vascular Anastomosis Surgery

  • Paul M. N. Werker
Part of the Contemporary Cardiology book series (CONCARD)


Irrespective of vessel size or specific technique, manual suturing remains the golden standard for the creation of vascular anastomosis. Successful creation of anastomosis, particularly in small vessels, requires a high level of skill, a long learning curve and a substantial amount of time. In addition, the insertion of transmural stitches, even by experienced hands using atraumatic techniques and fine sutures, causes significant damage to the vessel wall (1,2). Suture placement results in exposure of the subendothelial matrix to the blood stream, setting up a nidus for thrombus formation. The same process occurs at the site of the anastomosis in the case of an end-to-end apposition. These thrombotic processes can potentially result in anastomotic obstruction, especially in small vessels. Because of these limitations, a continuous search for alternative methods to anastomose vessels has been at the forefront of vascular surgery and industry alike. The introduction of loupe and microscopic magnification and the development of microsurgical instruments and techniques (3), however, have improved patency rates of small vessel anastomoses. These progresses in surgery have enabled revascularization procedures of the brain and distal limbs, free tissue transfer, replantation of digits, and coronary bypass surgery.


Laser Welding Fibrin Glue Patency Rate Vascular Anastomosis Coronary Bypass Grafting 
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  • Paul M. N. Werker

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