Procedures

Arteriotomy, Basic suture techniques

Learning targets

  • To always apply intravenous heparin  before arterial clamping (except patient has a history of heparin induced  thrombopenia (HIT)
  • To understand the important differences between ‘clamping’ devices (e.g. DeBakey vascular clamp vs Overholt clamp)
  • To apply arterial clamps correctly (pay attention to orientation of calcified plaques)
  • To perform arteriotomy correctly  (Nr. 11 scalpel (upwards!) and Potts scissors)
  • To handle forceps correctly to avoid  damage to arterial walls (don’t squeeze)
  • To position needle correctly in the needle holder (usually 1/3 to 2/3; 30°  forward)
  • To adopt  an ergonomic hold of instruments and position of body and arms
  • To stitch correctly through arterial walls  (perpendicular direction)
  • To direct stitches correctly: from inside out  in arteries and towards  outflow (to avoid dissection); from outside in in prostheses (and, if necessary, in  arteries towards inflow
  • To never grasp sutures with instruments (it can be damaged or break)
  • To always evert the arterial wall (to avoid contact of blood stream with adventitial  connective tissues)
  • To understand pros and cons of interrupted sutures vs running sutures
  • To understand optimal placement of the suture in  running sutures to ensure a tight suture (forward direction of every stitch,  shortest distance between stitch in and stitch out)
  • As assistant: where to hold a suture to  secure suture line, avoid loops of the remaining suture but give enough leeway for the next stitch (45% to 55% principle)
  • As assistant: to pull the suture in direction of the stitch,  and not backwards (to avoid pursestring effect
  • As assistant: to let the surgeon adapt the  tissues first before pulling the suture (to avoid suture hole  bleeding)
  • To always flush before closure, knotting and declamping

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All Steps in Detail
  1. 2x transverse / 2x longitudinal arteriotomies. Close both arteriotomies with both techniques: interrupted and running sutures, respectively
  2. Handling of arterial wall: grasp only adventitia with your forceps
  3. Proper clamping of the artery: pay attention to plaque, use a vascular clamp, adjust the force of the clamp, don’t forget to give heparin before clamping!
  4. Arteriotomy: use a s scalpel blade Nr 11, stab incision holding blade upward
  5. Extend arteriotomy using Potts scissors
  6. Handling of artery with forceps: don’t squeeze intima, use forceps as counterforce during the stitch, hold only adventitia
  7. Hold the needle holder correctly
  8. Position of needle correctly
  9. Stitch all wall layers with a perpendicular stitch (no tangential stitches)
  10. Direction of stitch inside-out (in arterial walls to avoid dissection)
  11. Interaction between needle, needle holder and forceps: pick up needle, plan next stitch

Control of learning targets

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Courses Teaching this Procedure

Basic Vascular Surgery Techniques 2026

Jan 18, 2026
 - 
Jan 20, 2026
More Information

Simulators Used for this Procedure

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The Vascular International (VI) School for Vascular Surgery is dedicated to advancing the training and education of vascular surgical techniques through the use of lifelike models. With patient safety as the top priority, VI continuously strives to enhance vascular surgery training, ensuring the highest standards of safe and effective open and endovascular patient care.

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