The distal, low pressure clamp is removed first. If there is no excessive leakage, the proximal clamp is removed slowly and under control to reclamp if necessary. There is invariably some initial leakage. The fat pad may be replaced over the anastomosis and the bleeding usually stops. If there is uneven suture placement and a large gap, an additional suture may be necessary.
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To test the patency of the anastomosis, the distal vessel is elevated with a forceps to the point where systolic/diastolic flicker can be seen. The flicker test is clinically useful since it doesn't damage the vessel. The true test of the anastomosis is whether it is patent later.
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