The tensile strength of a surgical suture is essential in maintaining the integrity of vascular anastomoses. While faulty operative technique and the loading strength of individual sutures have been implicated in spontaneous suture line disruptions, there has, to date, never been a published postmortem analysis of a suture that has known to have failed. We present the case of suture line disruption leading to fatal exsanguination in a 77-year-old man following carotid endarterectomy with a facial vein patch. Using both dissecting and scanning electron microscopy, we determined that surgical technique (an untied knot) was the cause of the suture line disruption. The removal of a broken or untied suture at surgery or at autopsy should not preclude proper analysis of the failed suture, because the results can have both medico-legal and public health implications.
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