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Kinking of reversed vein grafts is a recognized cause of early graft failure following femoropopliteal bypass. The commonly employed technique of marking one side of the vein prior to tunneling does not prevent graft twisting and kinking with absolute certainty, as proven by postoperative sonographic evidence. The authors herein describe a technique of tunneling the graft while distended, which resulted in no occurrence of either graft kinking or twisting based on ultrasound examinations of 44 reversed vein grafts over the past 3 years.