Figure 11

Miller cuff construction. (a) Vein cuff is sewn longitudinally around arteriotomy (b) graft is then sutured end-to-cuff. Using a cuff has adverse effects on hemodynamic factors around the anastomosis (e.g., large variations in shear stress on the artery floor, low-momentum recirculation within the cuff, and prominent separation at the cuff toe), and any improved patency rates achieved with cuffed anastomoses have been attributed to increased anastomotic volume and the consequent ability to accommodate IH, before it causes significant stenosis, rather than any decrease in IH (taken from [139] with permission).