ABSTRACT
On several occasions I have identified regions of thrombus and stenosis that appear to originate from a posterior atherosclerotic shelf protruding into the lumen of the vessel from the back wall. These have sometimes been persistent even after removal of the atheroma. In cases such as this my strategy has been to place a single vertical stitch in the same fashion as a tacking suture to hold this shelf down flat against the back wall of the vessel. This has worked nicely in the few cases in which I have used it and has not resulted in recurrent stenosis or postoperative thrombosis.
