Anastomoses: End to End

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- Discussion:
    - end to end anastomosis is usually begun with two corner sutures 180 deg
    - these may be placed as simple sutures, or horizontal matress suture;
    - w/ double ended vascular sutures, corner sutures are tied first, one
          needle from each corner is then used to run the suture line in a
          simple over and over fashion to middle of each side of anastomosis;
    - there the ends of the two sutures are tied together, completing the
          anterior anastomosis;
    - vessel ends are then rotated 180 deg by moving the vascular clamps,
          thus exposing the previous posterior half of the anastomosis;
    - suture line is then continued in an identical fashion to complete
          anastomosis;
    - if vessels to be joined are relatively small, eg. 2-5 mm in diameter,
          anastomosis may be enlarged by beveling the ends 45 deg in opposite
          directions;