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 Excimere (R) 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. (C) 2016 Published by Elsevier Masson SAS on behalf of SFCM.