Saphenous vein graft was harvested from the right thigh and explored from the left thigh with endoscopic Guidant system. Branches were clipped with Homoclips and the vein were prepared with heparinzed saline solution. The incisions were closed with subcutaneous 2-0 Vicryl and subcuticular 4-0 Monocryl for the skin.
Working at the same time, the right carotid artery was exposed through a supraclavicular transverse incision posterior to the sternocleidomastoid muscle. The artery was looped with vessel loops. The brachial artery was exposed just below the axilla and also looped with vessel loops with a longitudinal incison in the upper arm. A tunnel was created in between the cervical brachial incisons. A 4 x 7 mm PTFE graft was tunneled in between both incisions. The patient was heparinzed. Distal anastomosis was performed, first with a 4 mm end of the PTFE graft, end-to-side with running 6-0 Prolene. The graft was de-aired and proximal anastomosis was performed to the carodit artery, end-to-side with running 7-0 Prolene. Upon completion of de-airing, the flow was resumed. Good pulses were obtained distally at the wrist. Heparin was reversed with protamine. Very extensive hemostasis was completed, required Surgicel, thrombin and Gelfoam and 7-0 and 8-0 sutures. AFter extensive hemostasis and irrigation, the incisions were closed with soft tissue approximation of 2-0 Vicryl and subcuticular 4-0 Monocryl for the skin.