The saphenous vein is incised longitudinally throughout its length. A thoracostomy tube with a diameter approximating that of the innominate vein serves as a stent on which the spiral vein graft will be constructed. The vein graft is wrapped around the stent and secured with a 7-0 polypropylene suture. The graft is rolled onto the stent in spiral fashion, keeping a good tension on the vein graft. The edges of the vein graft are sewn together using 7-0 polypropylene suture for the length of the vein.
Optical magnification is to assure accuracy of the suture line.
About 20 to 30 minutes are required to complete this long suture line. Of the several advantages of the composite spiral vein graft, the ability to construct a tubular graft from autogenous tissue with living endothelium of any desired diameter and length stands out as significant. The innominate vein is occluded with a soft jaw clamp. The innominate vein is then divided. The distal end of the innominate vein, containing clot, is oversewn.