ABSTRACT
This series of photographs shows my design for a hemostatic and patent placement of the roof patch graft. The graft is first tapered at both ends with scissors, then anchored at both ends, as shown in (A) with inside-out sutures of double-armed 6-0 Prolene, taking special care to be certain that the bites on the CCA and ICA are deep, firm, and solid. I then proceed to suture the medial wall from ICA to ECA, taking bites with loupemagnified vision that are approximately 1 mm deep on both sides and 1mm apart, using a running, non-locking stitch, as show in (B). The loose end of this medial wall stitch is tied to one of the ends of the CCA anchor stitch with 10 knots. One is then able to peek at the inside of the vessel, shown in (C), to confirm the integrity of the suture line and to ensure that no clots have formed. Finally the lateral wall is closed by using the second arm of the ICA anchor stitch to come halfway down the lateral wall (D), where the stitch will ultimately be tied to a second arm which comes halfway up from the ICA (not illustrated).
