Current management of acute type B aortic dissection

Figure 4 Suture line reinforcement with felt pledgets. A: Performing the posterior wall of the anastomosis first, in a “parachute” fashion. The suture travels from the prosthetic graft, to native aorta, then finally through the pledget; B: The suture line is tightened with the use of a nerve hook, and care taken to place the pledge on the outer surface of the aorta; C: Once the posterior wall of the anastomosis is completed, the anterior wall of the anastomosis is completed. The graft is somewhat invaginated within the aorta; D: The completed anastomosis, whereby the native aorta is buttressed on either end with pledget and graft. Source: “Long-term integrity of teflon felt-supported suture lines in aortic surgery,” by Strauch et al[9]. Copyright 2005 by Elsevier, reprinted with permission.