The practice of joining blood vessels has been ongoing since the late nineteenth century, although it was initially restricted to animal studies and experimental techniques. At that time, fine silk thread and curved needles had been introduced (Jassinowsky, Inaug Diss Dorpat 1–103, 1889), which was a significant advancement on previous suture materials such as leather, tendon and catgut (Mackenzie, Med Hist 17(2):158–168, 1973), although they were used for wound closure rather than vascular repair. It was not until the mid-twentieth century, circa World War II, that vascular anastomoses were performed whilst repairing or reconstructing traumatic injuries (Rickard and Hudson, Ann Plast Surg 73(4):465–472, 2014). The natural progression from repairing vascular injuries was to perform these procedures in smaller and smaller vessels. Of course, this necessitated use of an operating microscope and development and manufacture of finer suture materials, needles and more delicate instruments. This chapter aims to provide details of the common microvascular anastomotic devices and their manufacture.