So you need to use a vein as a graft for a bypass. Definitely, it must not be long as it may kink leading to thrombosis. However, it must not be too short as there will be too much tension on the anastomosis. So, what is the proper length for a vein graft?

I will tell you about my practice. First, I do the “first” anastomosis (I almost always prefer to do the proximal one first, for various reasons). Then, I pass the graft at its tunnel (I usually prefer subcutaneously), taking care not to lose the proper vein orientation; bad orientation will end to graft twisting and occlusion.

Now, I need to cut the vein. How I do it? I stretch the vein down to the end of the arteriotomy of the target vessel. At this point, I cut the vein… 1 cm distally.

This way the graft has its proper length, leaving also an “air” of 1 cm. Usually, this extra length is not visible at all. If by mistake, seems to be longer than what it should be after the completion of the distal anastomosis, 1 cm vein length can be easily pulled back slighthly, leaving no redundancy at all.

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