The Perfect Hole
A good arteriotomy is essential for an end-to-side anastomosis. The hole should be elliptical and clean-cut, with even, steeply sloping edges. The hole should not have an irregular, ragged edge as it may weaken the wall and attract thrombosis. A well-made hole allows the surgeon to see the edges clearly, place the needle accurately, and tie sutures securely. Such a hole is hard to make, as every micro-vascular surgeon knows. Scissors just won't cut it.
Why Scissors Won't Cut it
The thick wall of a big vessel is tough and slippery. It has two layers which can separate with unappreciated ease, especially in older patients. Scissors don't just cut the vessel wall - they squeeze it, shear it, push it away, then cut it. Their action is unpredictable. Sometimes it's alarming. Sometimes it's dangerous. To make an accurate cut with scissors is difficult. Worst of all, scissors can separate a vessel wall into its two layers, cutting only the outer one and squeezing the inner one, uncut, into the lumen.
