Tip on creating dialysis graft venous anastomosis

A tip about doing the venous anastomosis of a dialysis graft.

When doing the dialysis graft creation, venous anastomosis is one of the important parts of the procedure. A smooth and wide open venous anastomosis is the important to the long term patency of the graft.
Usually, the target vein would became smaller than its original size because of vessel spasm due to the extensive dissection of surrounding tissue and manipulation of the vessel. Small target vessel lumen would add difficulties to the anastomosis. Here is a technique which can made the anastomosis easier.

I usually use a 19 gauge intravenous injection catheter as a simple tool to dilate the target vessel. The IC catheter is inserted into the lumen of the target vein after proximal and distal clamping of the vein. From the IC catheter, normal saline is gently injected. The target vein is thus dilated to a bigger size under the pressure. Then, from the tiny injection hole, I can make a longitudinal incision for following anastomosis.
The graft end will be sutured easily to the dilated target vein. Thus a wider anastomosis can be created.