Remember to keep the stitch loops extended like a parachute’s suspension lines, during the first bites of the anastomosis, by applying tension on the graft against the vessel. After the first 4-5 stitches have been completed, tack down the graft on the vessel. Then, a continuous tension must be applied to the stitch by the operator’s assistant at every stitch passage. Note that the surgeon can do this only by holding the stitch inside the handful of his/her non-dominant palm with the stitch coming in from the ulnar part of the palm and holding it down with the little and ring fingers.

Here are the steps to follow:

  1. Put the graft to be anastomosed on a parallel orientation to the vessel.
  2. Grab the end of the suture with a rubbered shot and let on the opposite side from you. With the other end of the suture, start from the opposite side at 8 o’clock and get from outside-inside (out-in) on the graft. With the same needle, get in the vessel at 8 o’clock, in an in-out direction.
  3. Use the same needle out-in on the graft toward the 7 o’clock position and then on the same position on the vessel in-out.
  4. Follow the same rule until you complete the ¼ of the anastomosis. Keep in mind to put about 3 stitches on every side of the anastomosis.
  5. After the ¼ of the anastomosis has been completed, start with the other needle, reversing its course on the graft out-in and then on the vessel in-out (NOTE: after the first stitch, this needle will be outside the graft already). Continue until the completion of the last ¾ of the anastomosis.