Tips and tricks for end-to-side anastomosis arteriotomies

Arteriotomy is a critical step during end-to-side anastomosis procedures. However, it is challenging to carry out because of the concentric lamellar structure of blood vessels and the need for clean margins. We performed a review of the literature to identify the advantages and disadvantages of the available arteriotomy methods. The techniques were classified into (1) single-cut or slit arteriotomy (longitudinal and transverse) or (2) excision arteriotomy. The latter techniques can be performed from either outside-in (excision with straight microscissors, curved microscissors, Acland-Banis arteriotomy clamp, micro-arteriotomy scissors, or triangular cutting scissors, and vaporization with Excimer(®) laser) or inside-out (excision with punch/micropunch). Microsurgeons have multiple arteriotomy methods at their disposal. By being familiar with these methods, they can select the most appropriate one for the situation at hand.