Fundamentals of Vascular Anastomosis

Abstract

While subspecialty training is ubiquitous in the current era of surgical education, there remain fundamental aspects of these subspecialties that are still critical in general surgery training. The proper construction of a vascular anastomosis is a necessary tool in the arsenal of any general surgeon. This chapter will review the history and basic principles of vascular surgery, including the methods and maneuvers required to safely gain vascular control. We will describe the important anatomic features inherent in an anastomosis and their physiologic consequences. Various approaches to anastomotic suturing will be described in detail, with a focus on precise surgical technique and the clinical circumstances in which each might be most applicable. Finally, the potential complications of anastomotic creation will be reviewed, with a brief overview of emergency maneuvers that can be employed in the event of uncontrolled situations. These valuable skills will allow a general surgeon to safely gain vascular control in the event of hemorrhage, repair an injured vessel, and create a bypass around an unsalvageable vascular injury.

Appendix

Below is a compilation of photos demonstrating basic instruments used in vascular surgery for creating an anastomosis. This is by no means an exhaustive list but rather serves as a general overview of instruments that can be utilized.

A variety of vascular clamps are used to gain vascular control on peripheral blood vessels.

A variety of instruments are used to obtain vascular control on small and delicate vessels. Bulldogs clamps (top row) of different sizes are made in metal and plastic and can be useful in controlling side branches of major vessels. Gold Yasargil clamps (bottom, right) are placed with a Yasargil applier (bottom row).

Locking and non-locking Castroviejo needle holders (top row) are generally used for suture 5-0 or smaller. Ryder needle holders can be used for more sturdy needles and suture.

Castroviejo needle holders are used to perform vascular suturing with small caliber needles and suture.

An olive tip (top) or Stoney (bottom) heparin injector can be used to flush blood vessels and anastomoses prior to repair or closure, to ensure evacuation of air and debris.