Do you want to know a good trick for the very-very distal anastomosis on a distal bypass?

Do not put a distal clamp on the target vessel. Let it free to back-bleed. Just make the anastomosis. Put your assistant holding the “sucker” just by the artery, and put in your stitches. Get prepared to lose some blood. But believe me. This is for good.

Why to do this? It is the only way to avoid crushing the run-off vessel. A crushed vessel may mean crushed plaque and… graft occlusion.

Have a quick look here:

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