An anastomosis (plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal (such as the foramen ovale in a fetus's heart) or abnormal (such as the patent foramen ovale in an adult's heart); it may be acquired (such as an arteriovenous fistula) or innate (such as the arteriovenous shunt of a metarteriole); and it may be natural (such as the aforementioned examples) or artificial (such as a surgical anastomosis). The reestablishment of an anastomosis that had become blocked is called a reanastomosis. Anastomoses that are abnormal, whether congenital or acquired, are often called fistulas.

Circulatory

In circulatory anastomoses, many arteries naturally anastomose with each other; for example, the inferior epigastric artery and superior epigastric artery, or the anterior and/or posterior communicating arteries in the Circle of Willis in the brain. The circulatory anastomosis is further divided into arterial and venous anastomosis. Arterial anastomosis includes actual arterial anastomosis (e.g., palmar arch, plantar arch) and potential arterial anastomosis (e.g. coronary arteries and cortical branch of cerebral arteries). Anastomoses also form alternative routes around capillary beds in areas that don't need a large blood supply, thus helping regulate systemic blood flow.

Surgical

An example of surgical anastomosis occurs when a segment of intestine, blood vessel, or any other structure are connected together (anastomosed). Examples include intestinal anastomosis, Roux-en-Y anastomosis or ureteroureterostomy. Surgical anastamosis techniques include Linear Stapled Anastomosis, Hand Sewn Anastomosis, End-to-End Anastomosis (EEA).Anastomosis can be performed by hand or with an anastomosis assist device.Studies have been performed comparing various anastomosis approaches taking into account surgical "time and cost, postoperative anastomotic bleeding, leakage, and stricture".

Pathological

Pathological anastomosis results from trauma or disease and may involve veins, arteries, or intestines. These are usually referred to as fistulas. In the cases of veins or arteries, traumatic fistulas usually occur between artery and vein. Traumatic intestinal fistulas usually occur between two loops of intestine (entero-enteric fistula) or intestine and skin (enterocutaneous fistula). Portacaval anastomosis, by contrast, is an anastomosis between a vein of the portal circulation and a vein of the systemic circulation, which allows blood to bypass the liver in patients with portal hypertension, often resulting in haemorrhoids, oesophageal, or caput medusae.

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