You have clamped a segment of vessel that does not have collateral vessel stumps midway between the approximator clamps. The arteriotomy should be
performed right here.
Grasp the adventitia with a forceps close to the designated cutting line. Holding it steady and close to the scissors joint will prevent it from rolling or sliding out from between the scissor blades while cutting. Keep your opened scissors perpendicular to the vessel; verify that the scissors are not rotated around their long axis and that the vessel is placed sufficiently deep between the scissors blades. Then perform the cut.
Arteriotomy – pitfalls, tips and tricks
If you fail to hold the scissors perpendicular to the vessel, or hold them rotated around their long axis, this will lead to an irregular cut.
If the vessel is not held sufficiently deep between the scissors blades it may partially slip out during cutting.
If the vessel is not grasped close to the scissors joint, it may rotate during cutting.
Preparation of the vessel ends
Immediately after cutting the vessel, gently open up the vessel stumps. Rinse them with a high-pressure water jet, keeping the tip of the catheter out of the lumen. Then remove most of the water and blood. If any blood remains inside the vessel stump, gently brush it out with the smooth outer edge of an instrument.
To keep tissue from hanging into the vessel lumen, grasp the soaked adventitia, pull it over the cut edge and cut it off. Continue until a ring of adventitia all around the vessel stump has been trimmed. Do the same on the opposite side.
If you experience difficulty with performing this procedure, do not worry. It is much simpler in living tissue.
When working with a living model, you will want to dilate the vessel to up to one and a half times its normal size and paralyze its smooth muscle. To do this, carefully insert your vessel dilator into its lumen, hold it open, grasp the adventitia with a forceps and rotate the vessel itself 180 degrees around the dilator.
Preparation of the vessel ends – pitfalls, tips and tricks
Be careful not to cut into the deeper layers of the vessel wall.
Do not insert your forceps into the lumen to grasp the vessel wall, as this could potentially harm the intimal layer.
Try to avoid uncontrolled movements that could potentially lead to a distorted cut edge.
Do not insert the vessel dilator into the vessel obliquely from either side or from above, otherwise you may harm the intimal layer.
If you do not insert the vessel dilator sufficiently deep into the lumen, it may slip out during dilation.