Minimally Invasive Vascular Surgery and the Evolution of Vascular Anastomosis Techniques

The evolution of vascular surgery toward minimally invasive approaches appears to be inevitable. Thus, innovative and reliable minimally invasive anastomosis techniques are needed to facilitate minimally invasive vascular surgery. Current endovascular anastomosis techniques are limited by their reliance on suitable arteries for access and attachment. Their dependency on the fate of the arterial attachment sites is greater than for the conventionally sutured anastomosis. These limitations will be difficult to over come. Videoscopic anastomosis techniques may offer both the advantages of endovascular surgery in terms of rapid postoperative recovery and reliability of open-sutured anastomosis. With improved training and instrumentation, such as robots, semiautomatic or automatic anastomotic devices, the video scopic approaches will likely become technically easier. The chief disadvan tage of current open-sutured anastomoses is the invasive exposure required, elevated morbidity and mortality, and associated prolonged hospital stay and convalescence period. Development of automatic or semiautomatic anastomosis techniques could decrease the invasiveness of these operations. Further research will help understand the interaction of the artificial agents with the arterial wall and will define what constitutes a perfect and durable anastomosis. This, in turn, will allow for the ideal anastomosis technique to become reality, and for widespread application of minimally invasive approaches in vascular surgery.