An Improved Technique
for Coronary Vascular Anastomosis Bernard L. Huang, M.D., Richard H. S. Moon, M.D., Philip A. Faraci, M.D., Benedict D. T. Daly, M.D., and Irving M. Madoff, M.D. ABSTRACT A vein hlolder is described that is used for anastomosis of botlh ends of aortocoronary bypass grafts. It minimizes handling of the graft, ensures precision in placing sutures with excellent visualization, and provides maximum patency at the anastomotic sites.
The extensive experience with aortocoronary bypass over the past several years has led to many new ideas to facilitate the technical performance of this prccedure. We have developed a type of vascular anastomosis that minimizes trauma to the endothelial surfaces and provides an optimal outflow tract. The essential feature of the technique involves placement of a single, continuous, double-armed running suture at the heel of the anastomosis prior to seating the graft; the entire suture line is then completed with only one knot, located at the broadest portion of one side. T!he technique is based upon the design of a vein holder* with a hollowbeveled tip with which the graft is held while the initial portion of the anastomosis is accomplished (Fig 1). The end of the graft is cut and tailored to the desired size and shape. After the vein holder has been introduced, a single suture is placed through the apex of the graft and tied to a hook or a fixed point on its posterior aspect. The hollow bevel of the ho’lder provides easy exposure of the heel of the graft (Fig 2 ) . The anastomosis is begun by placing an everting mattress suture of double-armed 6-0 or 7-0 Prolene at the 4-o’clock position; then a running suture is placed around the angle at the heel to the 8-o’clock position (Fig From the Department of Cardiothoracic Elizabeth’s Hospital, Boston, MA.
Surgery, St
Accepted for publicaticln Aug 24, 1976. Address reprint requests to Dr. Huang, 1180 Beacon St, Brookline, MA 02146. *Huang vein holder, Codman & Shurtleff, Inc, Randolph, MA 02368.
474
3). The graft is seated by traction on both ends of
the suture, and then the vein holder is removed. Anastomosis is completed by running one end of the suture around the apex of the graft and tying at the midpoint of the opposite side. We have found that this technique minimizes handling of the graft and the native vessel with forceps or by hand and provides optimal visualization of both orifices at the most difficult angle of the anastomosis. It virtually eliminates anastomotic leaks. The even distribution of tension over a broad surface while the graft is being seated reduces the likelihood of vascular tearing. It avoids the necessity of a knot at the heel or apex of the anastomosis, thus preserving maximum caliber of the outflow orifices at both ends of the anastomosis. This technique has been applied at both ends of aortocoronary bypass grafts as well as at the intermediate anastomosis in sequential grafts, where it greatly facilitates exposure. This method has been used successfully in more than 200 consecutive coronary anastomotic procedures. It has also been applied in femoropopliteal bypass procedures, in arteriovenous fistula for hemodialysis, and in renovascular anastomosis for hypertension. In addition to the advantages mentioned previously, this technique reduces the time required for an anastomosis, thus diminishing the likelihood of complications,
475
How to Do It: Huang et al: Coronary Vascular Anastomosis
Fig I . Huang vein Iiolder.
Fig3. ( A )Method of suture placement between vein on holder and aorta. ( B ) Suture placement between vein and coronary artery. (C) Detail of suture placement.
Fig2. Vein holderwith heelofgraft in positionfor anastomosis.
for Coronary Vascular Anastomosis Bernard L. Huang, M.D., Richard H. S. Moon, M.D., Philip A. Faraci, M.D., Benedict D. T. Daly, M.D., and Irving M. Madoff, M.D. ABSTRACT A vein hlolder is described that is used for anastomosis of botlh ends of aortocoronary bypass grafts. It minimizes handling of the graft, ensures precision in placing sutures with excellent visualization, and provides maximum patency at the anastomotic sites.
The extensive experience with aortocoronary bypass over the past several years has led to many new ideas to facilitate the technical performance of this prccedure. We have developed a type of vascular anastomosis that minimizes trauma to the endothelial surfaces and provides an optimal outflow tract. The essential feature of the technique involves placement of a single, continuous, double-armed running suture at the heel of the anastomosis prior to seating the graft; the entire suture line is then completed with only one knot, located at the broadest portion of one side. T!he technique is based upon the design of a vein holder* with a hollowbeveled tip with which the graft is held while the initial portion of the anastomosis is accomplished (Fig 1). The end of the graft is cut and tailored to the desired size and shape. After the vein holder has been introduced, a single suture is placed through the apex of the graft and tied to a hook or a fixed point on its posterior aspect. The hollow bevel of the ho’lder provides easy exposure of the heel of the graft (Fig 2 ) . The anastomosis is begun by placing an everting mattress suture of double-armed 6-0 or 7-0 Prolene at the 4-o’clock position; then a running suture is placed around the angle at the heel to the 8-o’clock position (Fig From the Department of Cardiothoracic Elizabeth’s Hospital, Boston, MA.
Surgery, St
Accepted for publicaticln Aug 24, 1976. Address reprint requests to Dr. Huang, 1180 Beacon St, Brookline, MA 02146. *Huang vein holder, Codman & Shurtleff, Inc, Randolph, MA 02368.
474
3). The graft is seated by traction on both ends of
the suture, and then the vein holder is removed. Anastomosis is completed by running one end of the suture around the apex of the graft and tying at the midpoint of the opposite side. We have found that this technique minimizes handling of the graft and the native vessel with forceps or by hand and provides optimal visualization of both orifices at the most difficult angle of the anastomosis. It virtually eliminates anastomotic leaks. The even distribution of tension over a broad surface while the graft is being seated reduces the likelihood of vascular tearing. It avoids the necessity of a knot at the heel or apex of the anastomosis, thus preserving maximum caliber of the outflow orifices at both ends of the anastomosis. This technique has been applied at both ends of aortocoronary bypass grafts as well as at the intermediate anastomosis in sequential grafts, where it greatly facilitates exposure. This method has been used successfully in more than 200 consecutive coronary anastomotic procedures. It has also been applied in femoropopliteal bypass procedures, in arteriovenous fistula for hemodialysis, and in renovascular anastomosis for hypertension. In addition to the advantages mentioned previously, this technique reduces the time required for an anastomosis, thus diminishing the likelihood of complications,
475
How to Do It: Huang et al: Coronary Vascular Anastomosis
Fig I . Huang vein Iiolder.
Fig3. ( A )Method of suture placement between vein on holder and aorta. ( B ) Suture placement between vein and coronary artery. (C) Detail of suture placement.
Fig2. Vein holderwith heelofgraft in positionfor anastomosis.
