Technique to prevent aortic anastomotic bleeding and kinking with bifurcated PTFE grafts

The bifurcated polytetrafluoroethylene (PTFE) graft was introduced for use in aortic reconstructive procedures in 1980. Despite reports showing excellent patency rates and minimal complications, widespread acceptance of this graft has not been optimal. Bleeding from needle holes at the proximal aortic-PTFE anastomosis has caused particular concern. In addition, because the PTFE is comparatively more rigid than the Dacron material it has a tendency to kink or "buckle" anteriorly due to displacement by the oversewn distal aorta. This paper describes the creation of an everted cuff of PTFE bifurcated graft to prevent aortic suture-line bleeding, and stapling of the distal aortic stump to avoid graft displacement and kinking at the bifurcation.