title: End-to-end versus end-to-side proximal anastomosis in aortobifemoral bypass surgery: does it matter?
abstract: The proximal anastomosis is still a controversial issue in vascular surgery. To compare end-to-end (EE) and end-to-side (ES) proximal anastomoses, the authors undertook a prospective study with 3 years' follow-up involving 120 patients, all of whom had aortobifemoral bypass. Fifty-one (42.5%) patients received the EE and 69 (57.5%) the ES anastomosis. The indications for surgery were abdominal aortic aneurysm (EE 51%, ES 0%; p less than 0.05), claudication (EE 33.3%, ES 53.6%; p less than 0.05) and critical ischemia (EE 15.7%, ES 46.4%; p less than 0.05). Patients in the EE group were older (mean age: EE 66.1 +/- 2.8 years, ES 60.9 +/- 1.1 years; p less than 0.05) and had more ischemic heart disease (EE 39.2%, ES 27.5%; p less than 0.05). Postoperative mean increases in transcutaneous oximetry (EE 15.5 +/- 3.9 mm Hg, ES 12.6 +/- 2.3 mm Hg) and the ankle-brachial pressure index (EE 0.34 +/- 0.05, ES 0.30 +/- 0.03) were not significantly different in the two groups. The operative death rate was higher for the EE group (EE 11.8%, ES 1.4%; p less than 0.05). Early thrombosis occurred in six patients, two in the EE group and four in the ES group. Computed tomography, done 1 year postoperatively in 95 patients, revealed two small (less than 3 cm) distal anastomotic dilatations, one in each group. At 3 years, cumulative survival and patency were similar in both groups. The authors conclude that the two anastomotic groups had very similar short- and long-term results, except for the operative death rate which was higher in the EE group.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Vascular Surgery, Wellesley Hospital, University of Toronto, Ont.
authors.forename: F M
authors.initials: FM
authors.lastname: Ameli
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: L
authors.initials: L
authors.lastname: Aro
authors.forename: J L
authors.initials: JL
authors.lastname: Provan
authors.forename: R
authors.initials: R
authors.lastname: Gray
authors.forename: H
authors.initials: H
authors.lastname: Grosman
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D001012:Aorta, Abdominal / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D015996:Survival Rate; D014654:Vascular Patency