The start of the back wall suture line is shown schematically. The first stitch is placed outside to in on the vein side so as not to draw the knot into the anastomosis. Subsequent stitches are inside to out on the artery in order to not separate intima from media, especially in an atherosclerotic artery like this one. The second half of each stitch is outside to in on the pliable vein.
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