This document provides instructions for various vascular anastomosis techniques: 1) It describes basic principles such as minimal incisions, careful tissue handling, and proximal and distal vessel control. 2) Transverse arteriotomy and embolectomy are explained, involving making an incision, inserting a stay suture, and closing with interrupted sutures. 3) Longitudinal arteriotomy and patch closure involves using a vein patch graft sutured with an everting technique or wrapped around the vessel edge. 4) End-to-end and end-to-side anastomoses are demonstrated, with placement of pursestring or spatulated sutures to approximate the vessels.

1. Vascular
Strasbourg, February 2001
• Basic principles
• Transverse arteriotomy, embolectomy & closure
• Longitudinal arteriotomy & patch closure
• End to end anastomosis
• End-side anastomosis

2. Basic Principles
Strasbourg, February 2001

3. Basic Principles
• Incision placement
• Minimal incisions
• Anatomical approach
– preoperative assessment
• Tissue handling
• Careful dissection
• Proximal & distal control
• Anticoagulation
• Precision of technique
• Checking

4. Incisions & tissue handling
Anatomy
preoperative assessment

5. Dissection

6. Control

7. Transverse arteriotomy
& embolectomy
Strasbourg, February 2001

8. Transverse arteriotomy
Hold vessel firmly

9. Embolectomy
stay
Place double ended stay in distal edge

10. Rule 1
Rule 2
Rule 3
Vascular suturing

11. Closure (safe)
• Place all
sutures
• Interrupted
double
ended
• Tie from
corners

12. Closure (safe)

13. Closure (large vessel)
Continuous suture
= risk of narrowing
Large vessels only

14. Longitudinal arteriotomy
& patch
Strasbourg, February 2001

15. Longitudinal arteriotomy

16. Vein patch 1

17. Vein patch 2
Everting suture

18. Trim tip

19. Suture back from toe
Alternative:
suture around the toe
finish on the “near side”

20. Alternative

21. End to end anastomosis
Strasbourg, February 2001

22. End to end (Carrel)

23. Large vessel

24. Pursestring

25. Small vessel

26. Suture placement

27. Suture placement

28. Suture placement

29. Closure

30. Spatulated

31. Heel to toe

32. Continuous suture

33. End to end – caution!

34. End to side anastomosis
Strasbourg, February 2001

35. End to side

36. Spatulate vein

37. Heel suture

38. Toe suture

39. Alternative

40. Avoid narrowing artery (toe)

41. Strasbourg, February 2001

42. Laparoscopic
appendicectomy
Strasbourg, February 2001

43. Port placement

44. Mobilise appendix

45. Mesoappendix

46. Mesoappendix

47. EndoGIA

48. Removal of appendix