A Simple Technique to Prevent Torsion and Other Obstructions of Autogenous Vein Conduits

During a bypass or a transposed fistula, there is a risk of twisting or torsion of the vein within the tunnel, which may not be easily apparent when incomplete. When valvulotomes are used some nonobstructing leaflets or flaps may remain. These mechanical problems may go undetected at the time and may cause hemodynamic changes, act as a nucleus for thrombosis, or obstruction postoperatively. These may result in early graft failure. A simple technique to prevent and treat twisting and other obstructions in autogenous venous conduits is described. Use of this method has helped the authors to avoid acute obstructions in vein bypasses and transposed dialysis access fistulas.