Background and approximator placement
A large piece of background material is placed underneath the aorta. The approximator is set at its maximum distance and placed on the aorta from either side.
Preparation of the vessel ends and graft
The aorta is cut about midway between the approximator clamps. It generally retracts leaving a space that is large enough for the femoral vein graft.
Nonetheless, we remove a short segment of aorta, since small gaps between the vessel’s cut edges provide: (a) better visibility of the needle inside the vessel lumen while placing stitches, and (b) a better appreciation of tension while tying knots. An elegant way of doing this is to grasp the full thickness of the freely movable vessel stump parallel to the cut edge with the plateau of a forceps, to fix the vessel in space.
Now irrigate the vessel stumps and brush them out with the smooth outer edge of an instrument, if necessary. Clean the operating field. Dilate the stumps only if they are spastic. Otherwise proceed to the adventitiectomy.
Here the vein graft is positioned between the arterial vessel stumps. It still needs to be dilated to become a closer match in size to the aorta.