A successful
vascular anastomosis involves a meticulous technique which includes gentleness
in handling absolute asepsis and extreme care in placement of sutures.
The ends are approximated and two
stay sutures are placed at equidistant points usually at the corners. The
sutures are held to steady the vessel and to rotate the vessel if required
while the anastomosis is being performed around the circumference.
Over and over sutures are placed at 2mm
intervals 2mm from the edge for anastomosis.
Alternatively the ends may be spatulated
to reduce the incidence of stenosis. Posterior wall is anastamosed undervision
initially with a running suture and drawn together. It is then continued around
the front wall.
End-Side anastomosis
IN ACCESSIBLE SITES
When this type of anastomosis is carried
out in a well exposed and accessible site initial stay sutures are placed
at the heel and later at the toe.
Anastomosis is then performed circumferentially
beginning with posterior wall (away from the surgeon ) first and later on
the anterior wall.
IN INACCESSIBLE SITES
When the anastomosis takes place at a deep
and poorly accessible region parachute
technique may be followed with initial sutures
on the heel both anterior and posterior aspect.
Sutures are then drawn together and the
anastomosis is completed with circumferential sutures.
