Use of a micropunch for arteriotomy in end-to-side anastomosis.

A micropunch can mechanically create a precise, clean microarteriotomy that is a simple and perhaps more accurate method, especially in atherosclerotic vessels where plaque or the risk of intimal dissection may sometimes interfere with conventional incision or excision techniques. A 1.5-mm. prototype micropunch was tested in seven Sprague-Dawley rats to create;l an end-to-side femoral vein to artery fistula, with a traditional traction suture method used on the contralateral side as a control. All anastomoses were patent immediately and at 2 weeks, implying no compromise, even in small vessels, by using a micropunch. However, the technique had to be modified, as the 1.5-mm anvil could not be inserted directly into the vessel lumen because of the small size of the rat femoral artery. This indicates a significant limitation of this device for use in vessels with an internal diameter less than that of the chosen anvil size.