Two-Point Fixation

The anastomosis is started on the bottom, in which a knot is tied. A second suture is placed on the opposite side of the first knot (Figure 7). This can either be tied down or tagged to assist with offloading tension. Sutures may be placed in a running fashion from either knot and met in the middle (Figures 7 and 8). This technique is helpful when sewing vessels that are under some tension, but some surgeons always prefer this method.