To assess the safety and efficacy of polydioxanone suture (PDS) for vascular anastomoses, bilateral carotid end-to-end anastomoses using PDSs on the left and Dacron sutures on the right in 18 dogs were performed. The anastomoses were assessed at 4, 6 and 8 weeks after surgery. A breaking-strength test (300 mmHg) did not show a significant difference between PDS and Dacron anastomoses, but partial absorption was grossly evident in the PDS group. Some 35 venous and 21 arterial reconstructive procedures were also carried out using PDS in 53 patients. At follow-up of 3-5 (mean 3.5) years, none of the patients had experienced any suture-related complications. The results indicate that PDS maintains an adequate tensile strength in anastomoses until suture-line healing occurs, suggesting that this material may be safely used in venous or small arterial anastomoses. In addition, because it is absorbable, resulting in decreased foreign-body reactions, PDS may have the potential to improve the long-term patency of venous or small arterial reconstructions.