Anastomotic concept – 120 degrees, 12 stitches, 2 times
Two 120-degree, 12-stitch anastomoses will be performed in this example.
As for all vein exercises, the entire procedure should be performed partial or complete submersion to prevent the vessel walls from collapsing and adhering to each other.
One solution to this specific situation is to position the arterial ends and vein graft accurately, and to place stitches one and two of both the proximal and the distal anastomosis before placing the remaining stitches.
Once the first two knots are tied on both anastomoses, the graft no longer floats about freely.
It is crucial to place these first stitches precisely, so that you can place the remaining stitches with relative ease.
Anastomoses – 120 degrees, 12 stitches, 2 times
Here are stitches one and two, placed 120 degrees apart on the proximal anastomosis. Stitches one and two on the distal anastomosis fix the graft between the arterial vessel ends. All consecutive stitches are placed according to the 120-degree, 12-stitch concept. Here is the finished graft.
If your graft is patent, cover it up with moist gauze and leave it alone for 20 minutes. Then test its patency once more. You can use the same vessel to repeat the exercise, using the contralateral contralateral femoral vein or neck vessels. If the anastomosis proves patent, you can work on the femoral vessels. If it does not prove patent, you can work on the neck vessels.