Alternative suture technique for anastomosis of veins with different diameters

Microvascular anastomosis of vessels that differ in diameter can be technically difficult and time-consuming. Difficulties with positioning may lead to kinking or compression, and bleeding at the anastomosis can be a problem. Turbulence and sluggish flow in dilated vessels can predispose to thrombosis.
End-to-side anastomosis eliminatesthe problem of redundancy of the vessel wall, but requires suitable anatomy to avoid kinking or compression, and provides sufficient space for movement when the posterior wall is sutured. Because of these issues an end-to-end anastomosis, together with a technique to reduce the calibre of the vessels, could provide more reliable options.
Several techniques have been described and proposed for solving discrepancies in the size of the vessels in reconstructive microsurgery.
Mechanical dilatation is one of the earliest procedures described and is commonly used for minimal discrepancy in the sizes of vessels, and it is sufficient when the ratio of the discrepancy is less than 1:5.3 When the discrepancy is bigger (from 1:3 to 1:4), itshould theoretically dictate an end-to-side anastomosis. The attachment of two vessels at 90◦, however, will create areas of turbulence, this is why microsurgeons are often prone to an end-to-end anastomosis using a technique to reduce the calibre of the larger vessel.