Use of the vascular punch in microsurgery

End-to-side microvascular anastomoses continue to present technical difficulties. We have recently modified our technique when performing arteriotomy, utilizing an available vascular punch. Experience to date with this technique has been encouraging in the performance of arteriotomy for end-to-side anastomoses. This technique has been particularly useful in patients with arteriosclerotic vascular disease. There have been no complications related to the technique, and we feel it may provide the best arteriotomy for end-to-side anastomosis.