A modified method of microvascular autogenous interposition vein grafting for vascular reconstruction.

A modified technique of vein grafting for vascular reconstruction that facilitates surgical procedures by preventing size, diameter, and length discrepancies as well as twisting, is presented. The distal end of the harvested vein graft is ligated, and the graft is inflated with heparinzed saline. The determination of the small side branches makes ligation easier. Gentle hydrostatic dilation relieves spasm, straightens the vein, and ligation of the proximal end is then performed under tension. As the vein inflated with heparinzed saline achieves maximum size, diameter, and length without torsion, the sausage-like graft can easily be interposed in tunnels, passages, or soft tissues between recipient vessel gaps. As the graft is under adequate tension, it is easy to determine its appropriate length, size, and diameter. Suturing is carried out using double approximating clamps. The graft will not twist or kink, as it is anastomosed under tension. The clamps are left in place until completion of the distal and proximal anastomoses. The distal clamp is released first. With this simple modification, most of the technical difficulties, such as length, size, and diameter discrepancies, and twisting and torsion of the graft, can be eliminated. The risk of failure due to vascular thrombosis at the anastomotic sites is lowered, as the vein graft is filled with heparinzed saline, and no blood flow is permitted during the reconstruction. The surgeon also saves time with this easy, simple, and feasible method.