There follow some tips to use when performing a vascular anastomosis. Remember to minimally handle the tissues, especially when dealing with an atherosclerotic vessel. Hard grasping with forceps can lead to intima damage, flap creation, and graft or vessel thrombosis.
- Needle Placement:
- Take a small bite on the adventitia and a larger bite on the intima.
- Symmetry in Stitches:
- Use symmetrical stitching whenever possible.
- If asymmetry is necessary, prefer normal-sized stitches on one side and smaller stitches on the other, rather than combining normal with larger stitches.
- Graft Preparation for Anastomosis:
- Synthetic Graft (large size): Cut in an S-shape (Fig.1, Dotted a line), with:
i. A small perpendicular cut at the start.
ii. A beveled cut in the middle.
iii. Another small perpendicular cut at the end. - Venous Graft (smaller size): Cut in a cobra-head shape (Fig. 2), with:
i. A longitudinal cut on the posterior wall.
ii. Beveled cuts at both toe ends.
- Synthetic Graft (large size): Cut in an S-shape (Fig.1, Dotted a line), with:
Images by:
- Rutherford, Atlas of Vascular Surgery, Operative Exposures and Techniques