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April 1953

"PLICATION": Method of Reducing the Caliber of Vein Grafts

Author Affiliations

From the Department of Surgery, University of Washington School of Medicine.

AMA Arch Surg. 1953;66(4):461-467. doi:10.1001/archsurg.1953.01260030476014

VENOUS grafts in the arterial tree have been used extensively in experimental surgery and in a number of instances in clinical work.1 Veins have the advantage of being readily available and of being autogenous vascular tissue which may be obtained without the sacrifice of vital parts or functions, as is the case with arteries. A vein of proper diameter cannot always be secured, however. The disadvantages of grossly oversized veins are the high incidence of early thrombosis, rupture at the suture lines, and excessive later dilatation. The latter factor is probably related more directly to the musculofascial support of an autogenous vein graft rather than to the graft-aortic disproportion present at the time of implantation.

Carrel2 described a method of reducing the caliber of vessels in situ by means of horizontal mattress sutures, which he termed "longitudinal exclusion," but did not, to our knowledge, employ it on free

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