Distal in situ vein bypass torsion--a technique to avoid it

One of the stated advantages of the in situ bypass is that twists or torsion along the vein are automatically prevented by the technique. Unfortunately, this is not strictly true because the distal mobilized end of the vein, which is being anastomosed to the outflow tract, is quite prone to twists of 180 to 360 degrees after its arterialization. This torsion may result in either immediate cessation of flow or later formation of an anastomotic stenosis. We describe a technique that, when used, should eliminate all such problems.