The "eaves" technique for distal anastomosis in aortic arch replacement

We describe the “eaves” technique, a new method for distal anastomosis in aortic arch replacement. The 1-cm wide eaves were created at the site 3 to 4 cm distal to the graft end. The graft was bound with vessel tape from the eaves to the site proximal to the origin of the first branch to make a working space above the eaves and to facilitate graft handling. Then the native descending aorta was sutured to the eaves easily. The eaves enabled a greater surface contact area between the graft and the inner wall of the aorta and reduced bleeding at the anastomosis.     

Spiral interrupted suturing technique for microvascular anastomosis: a comparative study

This is an experimental study comparing the suturing time and patency rate of a spiral interrupted suturing technique to those of conventional interrupted and continuous suturing technique in end-to-end as well as end-to-side anastomosis. The spiral interrupted suturing technique requires less time for either end-to-end or end-to-side anastomosis than conventional interrupted suturing technique, and does not result in stenosis as shown in the venous end-to-end anastomosis by continuous suturing technique.     

The "omega-anastomosis": a new revascularization technique for coronary bifurcations

We report the "omega-anastomosis," a new technique permitting the revascularization of both coronary branches beyond a bifurcation by using a single arterial graft. This technique consists of a longitudinal incision in the main coronary artery, which extends to both coronary branches beyond the bifurcation. The arterial conduit's distal extremity is cut vertically and tailored to produce a "bipetal" shape, which is used to enlarge and create an acceptable roof for both coronary branches beyond the bifurcation.     

Double telescopic anastomosis with interrupted suture technique in acute aortic dissection

We describe a new method for aortic anastomosis in the repair of acute aortic dissection. The anastomosis sites are prepared and sutured in an interrupted horizontal mattress manner with telescoping technique. By this kind of method, the interrupted sutures decrease damage to the fragile aortic wall and the antegrade blood flow promotes anastomotic sealing. This interrupted telescoping suturing technique will greatly help in managing aortic dissecting disease.     

Tube-graft inversion for the construction of an "open" distal anastomosis during ascending aortic replacement: a new technique

For the construction of a distal "open" anastomosis during ascending aortic replacement, a tube-graft is placed opposite to the transected aorta. We describe an alternative technique. The tube-graft is inverted and positioned within the aortic arch in a way that brings the entire circumference of the distal end of the tube-graft next to the circumference of the transected aorta. An end-to-end anastomosis is then fashioned with a running suture, the needle of which goes through the aorta and the tube-graft in a single pass. This technique permits easy, accurate, and fast suture placement, producing a hemostatic distal anastomosis within a short circulatory arrest time.     

Devising a technique for distal anastomosis during total arch replacement using the frozen elephant trunk technique: reverse stepwise anastomosis

Frozen elephant technique is an effective procedure used to repair complex thoracic aortic disease involving the aortic arch and the descending aorta, or to treat aortic dissection. However, the technique often requires some creativity to properly place the stent graft and anastomose the graft to the aorta. We recently used the J Graft FROZENIX® (Japan Lifeline Co., Ltd., Tokyo, Japan) in total arch replacement, and devise a technique for distal anastomosis (called “reverse stepwise anastomosis”) that was simple and easy and caused minimal bleeding.     

全腹腔镜下远端胃癌根治术三角吻合术

先确定肿瘤位置,沿横结肠边缘超声刀游离横结肠系膜前叶,向右游离至结肠肝曲,左至脾曲,离断网膜左血管,清扫4sb,4d淋巴结;沿结肠中动脉及其分支分离,向上暴露肠系膜上静脉、右结肠静脉、胃网膜右静脉,骨骼化胃网膜右动脉于根部切断;裸化十二指肠下缘,暴露胃十二指肠动脉,肝总动脉胃左脾动脉和腹腔干,切断胃左动脉清扫第7.8.9.11p组淋巴结;向下剥离裸化肝十二指肠韧带,清扫第12a组淋巴结,并向上彻底清扫第1,3,5组淋巴结,使用内镜下直线切割吻合器离断十二指肠球部,胃体。扩大脐部穿刺孔至取出标本,缝合切口。重建气腹,行胃大弯和十二指肠后壁三角吻合。     

How to tailor A "pi" graft for complex myocardial revascularization: a variant of the mammary loop technique

We present a new pattern for tailoring the “π” graft that uses the advantages of the mammary loop technique. The two internal thoracic mammary arteries are skeletonized. The free right mammary artery is anastomosed end-to-side to the proximal part of the in situ left mammary artery to make a “Y” graft. The distal end of the left mammary artery is anastomosed end-to-side to the middle portion of the right one to form a loop with the two arteries. The loop is severed at the appropriate level at the time of the coronary anastomosis to form a “π” graft. This technique allows a more rational use of the length of the two mammary arteries, because the branch leading to the left anterior descending artery is measured and cut precisely at the time of the anastomosis.     

Branched graft inversion technique for distal anastomosis in total arch replacement

Distal anastomosis during total arch replacement for thoracic aortic aneurysm is at times difficult, and bleeding from it is a serious problem because of its limited surgical exposure. We have modified a new procedure, the branched graft inversion (BGI) technique. We investigated the effectiveness of our technique by comparing it with the conventional stepwise technique. Between January 2008 and August 2011, 40 patients, divided into two groups of 20 each, underwent elective total arch replacement. One group underwent surgery using BGI; the stepwise technique was performed on the remaining 20 patients. Our modified BGI technique offers easy and secure distal anastomosis under good surgical procedure, resulting in shorter durations of operation, cardiopulmonary bypass, and circulatory arrest (455.1 ± 101.3 min versus 354.7 ± 49.3 min, p < 0.001; 248.2 ± 46.6 min versus 199.7 ± 28.2 min, p < 0.001; 76.6 ± 27.7 min versus 61.6 ± 10.4 min, p = 0.029, respectively). As a result, this technique could be a useful in performing total arch replacement.     

Avoidable errors in cardiac surgery: anastomosis of the left internal mammary artery to a vein

We report the case of a patient who had undergone a three-vessel coronary artery bypass graft surgery 6 years earlier, during which the left internal mammary artery was erroneously anastomosed to an epicardial vein instead of the intended target, an intramyocardial left anterior descending artery. Visually distinguishing artery from vein can be occasionally challenging and can lead to errors in distal anastomosis. This case report identifies two difficult problems in cardiac surgery and discusses the techniques to differentiate between arterial and venous targets.     

Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis

The authors describe the functional and aesthetic results of microsurgical replantation of 21 fingertip amputations at or distal to the nail base-namely, zone I amputations. There were 15 male and 6 female patients, with an average age of 26 years (age range, 1-41 years). Replantations were performed using the anastomosis of the artery-only technique, with neither vein nor nerve repair. Venous drainage was provided by an external bleeding method with a fish-mouth incision in "distal" zone I amputations for approximately 7 days, and by the use of leeches in more "proximal" zone I amputations for 10 to 12 days. Results indicated that the overall survival rate was 76%, with 16 of 21 digits surviving. Sensory evaluation at an average follow-up of 12 months (range, 6-18 months) revealed an average static two-point discrimination of 6.1 mm (range, 2.0-8.0 mm). Considering the unfavorable results and the donor site morbidity of various fingertip reconstructions, a microsurgical fingertip replantation should always be considered except in extremely distal, clean-cut, pediatric cases, in which case a composite graft is a possibility. The results of this series indicate that an amputated fingertip in zone I can be salvaged successfully by microvascular anastomosis of the artery only, with a nonmicrosurgical method of venous drainage. Furthermore, acceptable sensory recovery can be expected without any nerve coaptation.     

Internal mammary--coronary artery anastomosis. "No-touch" technique.

A simple technique for internal mammary--coronary artery anastomosis that can be applied to all branches of the coronary circulation is described. The anastomosis can be constructed in 10 to 15 minutes. This technique eliminates pinching of the internal mammary artery by forceps.     

Graft insertion technique for distal anastomosis in cases of ascending aortic aneurysm

We describe a simple and reliable technique of making a secure graft for aorta anastomosis, involving sandwiching the friable aortic wall between the graft and a Teflon strip. This technique makes possible a secure anastomosis with the distal friable tissue and prevents bleeding from the junction.