Suturing is continued around the artery, starting at
the far wall, the needle passing outside-in on the graft
and inside-out on the artery. An assistant follows, keeping
appropriate tension on the suture line.
Minimal handling of the artery, and especially the intima,
will reduce the risk of late thrombosis.
Sutures are placed in a clock-face pattern at the apices
of the repair. Once around the apex, the second needle
should be used to finish the first apex. This insures
that sutures are appropriately placed at the ends of the
Before closing the inflow and outflow are released to
remove any clot, and the artery flushed with heparinised
The suture is then tied on one side of the repair, away
from the apices.