End-to-end anastomosis between prosthetic grafts seems technically easy; however, bleeding from the needle hole or at the site of anastomotic discrepancy can be problematic. The pericardial sandwich technique helps to resolve this issue. The grafts are generally anastomosed to each other with a continuous suture, and a strip of autopericardium is sandwiched circumferentially between the two grafts. Although this anastomosis involves a special technique, it is not intricate. The pericardium effectively covers the needle hole and gap between the grafts. This method is useful for large-vessel surgery, especially in patients with coagulopathy.
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