You have made your anastomosis and there is a leaking point from it. You need to put a suture there. The usual approach is to put a polypropylene stitch on a figure-of-eight configuration. It is almost always adequate. However, occasionally the position of the point of bleeding may be not easy to put such a suture. Is there any alternative? 

Yes, there is. It is a “tent-suture”. What is a “tent-suture”? As it reads, it is suture that stops a bleeding from the anastomosis by creating a small tent over the bleeder. Here is how you make it.

Put the stitch on the artery side of the anastomosis along the anastomotic just opposite the bleeding point of the anastomosis. Then, you pass the needle on the bleeding point on the graft from inside-outside. Then just tie. In most of the times the bleeding stops. It is useful to remember this especially when the bleeding point is from an awkward point, as for example the posterior part of the anastomosis. 

You can see the steps in the following images.

Image 1: The stitch is inserted on the aortic wall, at a parallel orientation to the anastomosis, across the bleeding point, and then inside-outside on the graft.
Image 2: The two ends of the suture are tied together.
Image 3: Final view of the suture. The bleeding point has been stopped.

Check it live here

The “tent-suture” from Andreas Lazaris on Vimeo.

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