Spatulated versus end-to-end anastomosis for small vessel injury

Spatulated anastomosis (SA) was compared to end-to-end anastomosis (EEA) with small arteries (3-4 mm) in nine conditioned dogs (22-30 kg). A 1-cm segment of both common femoral arteries with an average of 3.5-mm external diameter was resected and reconstructed by EEA and by contralateral SA using a running suture of 5/0 proline. Pre- and postoperative flow rates, flow rates at 1 year in three dogs, arteriography at 1 year in six dogs, and gross examination at 1 year were done. The preoperative flow rates averaged 86 ml/min for the SA and 76 ml/min for the EEA; early postoperative flow rates averaged 100 ml/min and 92 ml/min, respectively, whereas 1-year flow rates averaged 63 ml/min and 57 ml/min, respectively. None of these differences is significant. Preoperative and 1-year external diameters averaged 3.54 mm and 3.39 mm in the SA group compared to 3.5 mm and 3.44 mm in the EEA group. Arteriograms showed good flow except for slight narrowing in one SA which, on postmortem exam, was seen to result from a fibrous band which extended from the spatulated segment to the opposite wall. These data show that SA and EEA yield comparable results both acutely and long term. The choice of EEA versus SA for primary repair of injured small vessels should be determined by surgical preference.