Vein graft is widely used in peripheral vascular surgery. Many free flaps and replantation failures are the result of technical problems in performing the anastomoses. A remarkable number of these technical errors are caused by tension or improper placement of the surgical union. Use of a vein graft may prevent tensioning and give us a more accessible repair site. However, the use of a graft not only doubles the repair side, but may also increase the risk of circulatory disturbance. Many technical, mechanical, and histological factors were cited as factors in the formation of thrombus. The use of a vein graft with a fatty tissue cover may prevent many of the potential risk factors.