In search of the "perfect" anastomosis

Forty-five end-to-side microvascular anastomoses were completed in rat carotid arteries of 0.7-0.8 mm diameter (anastomosing the distal end of the left common carotid to the side of the right common carotid). For comparison both 10-0 and 11-0 sutures were utilized in different anastomotic techniques: interrupted, direct-continuous, and diagonal-continuous sutures, plus total mural thickness vs. partial mural thickness (piercing only the adventitia and outer media, excluding the intima). Anastomoses were evaluated for patency and scanning electron microscopic appearance after 10 to 12 weeks. The results indicate complete patency in all anastomoses. Ultrastructural observations revealed nearly normal intimal appearance in the partial medial technique and only minimal evidence of intimal injury in the other techniques. It is concluded that 100% patency can be obtained regardless of suture size or anastomotic technique. The most important factor in anastomotic patency is the operator's technical skill.