IN JOINING together the tubular structures of the body, surgical craftsmanship approaches art. Successful anastomosis is based upon knowledge of the tube's structure, blood supply, mode of healing, and, above all, the properties of its contents. The means at hand are the smallest consideration.
The ideal vascular anastomosis represents a watertight junction sufficiently strong to resist lateral and longitudinal tension, whose inner surface offers neither mechanical nor biochemical inducement for thrombosis. The ultimate repair must not deform the lumen or hinder the growth of the vessel. In addition, the operation must be accomplished well within the safe time limit of occlusion for the area supplied by the vessel.
By the turn of the century, techniques necessary to the attainment of this aim, such as triangulation of the vessel and intima-to-intima approximation by means of everting sutures, had been devised.* However, the exacting and sometimes exasperating nature of blood vessel suture