Problems and Complications

- Inequality of vessel diameters (Figs. 14.14-14.16). - Early or delayed thrombosis at the anastomotic

- Gaps between the vessel ends (Fig. 14.17). site (Fig. 14.18).

Fig. 14.14 If the vessel calibers are nearly equal, the smaller lumen can be gently dilated with a forceps or retractor.

Fig. 14.15 Vessel calibers can also be matched by cutting the smaller vessel end at an oblique angle.

Fishmouth Incision
Fig. 14.16 Fish-mouth technique. The front and back walls of the donor vein are incised to enlarge the anastomotic lumen. This technique is particularly useful in an end-to-side anastomosis where the incision in the recipient vein has been made too large (Remmert 1995).

Fig. 14.17 Gaps between the vessel ends. The vessel ends must be apposed without tension, since traction on the anastomosis leads to thrombosis. Larger gaps should be spanned with an interpositional graft of equal diameter.

Fig. 14.18 Thrombosis. The most dreaded complication is anastomotic thrombosis. A clot that forms during suturing is flushed out with heparinized sodium-chloride solution. If the anastomosis has already been closed, the segment is excised and a new anastomosis is performed.

Fig. 14.17 Gaps between the vessel ends. The vessel ends must be apposed without tension, since traction on the anastomosis leads to thrombosis. Larger gaps should be spanned with an interpositional graft of equal diameter.

Fig. 14.18 Thrombosis. The most dreaded complication is anastomotic thrombosis. A clot that forms during suturing is flushed out with heparinized sodium-chloride solution. If the anastomosis has already been closed, the segment is excised and a new anastomosis is performed.

Test for Patency

Fig. 14.19 Test for patency. The patency of arterial and venous anastomoses can be assessed with the O' Brien test. a The vessel distal to the anastomosis is occluded with a forceps. A second forceps is placed next to the first. b Blood is milked distally with the second forceps, which is tightened to create an empty vascular segment. c The proximal forceps is released. If the empty segment quickly refills, the anastomosis is patent.

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