The arterial stitch must be tight, closing together one stitch to the other, independently of whether the suture is continuous or discontinuous.
Below is detailed the particular case of end-to-side continuous arterial anastomosis with aortic patch, using non-reabsorbable 9/0 monofilament with curved non-spatulated needle.
How to do it:
During renal extraction, note the shape and size of the aortic patch and make the arteriotomy in the aorta the same size. The patch is faced with the aorta in respect to the natural position of the renal artery so that it does not come off twisted.
1. The 9/0 monofilament and needle is passed from the outer part of the aortic patch to the inside of the patch.
2. The needle is passed from the aorta lumen (inside) to the outside of the aorta on the most caudal part. The first stitch is made with 3 double knots leaving an end long enough to finish the suture later.
3. The needle is passed from the outside to the inside of the aorta under the 1st stitch.
4. From the inside of the aorta the needle is passed through the aortic patch crossing it from inside to outside. This is made in a single movement.
5. Continue advancing along the perimeter of the arterial anastomosis until arriving to the most cranial extreme.
6. In the most cranial extreme the orientation of the suture is changed to outside, crossing the arterial wall from outside to inside and then from inside to outside for each stitch in a single movement.
7. Continue the suture until it arrives to the cranial extreme.
8. Knot both ends of the 9/0 monofilament with three double knots. Check the anastomosis for bleeding. Put in extra-stitches if necessary.
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