title: Why Patencies of Femoropopliteal Bypass Grafts with Distal End-to-End Anastomosis are Comparable with End-to-Side Anastomosis.
abstract: OBJECTIVE
  Despite the theoretical favourable hemodynamic advantage of end-to-end anastomosis (ETE), femoropopliteal bypasses with distal ETE and end-to-side anastomosis (ETS) have comparable clinical patencies. We therefore studied the effects of different in vivo anastomotic configurations on hemodynamics in geometrically realistic ETE and ETS in vitro flow models to explain this phenomenon.
  
  
  METHODS
  Four ETE and two ETS models (30° and 60°) were constructed from in vivo computed tomography angiography data. With flow visualization physiological flow conditions were studied.
  
  
  RESULTS
  In ETS, a flow separation and recirculation zone was apparent at anastomotic edges with a shifting stagnation point between them during systole. Secondary flow patterns developed with flow deceleration and reversal. Slight out of axis geometry of all ETE resulted in flow separation and recirculation areas comparable to ETS. Vertical flow patterns were more stable in wider and longer bevelled ETE.
  
  
  CONCLUSIONS
  Primary flow disturbances in ETE are comparable to ETS and are related to the typical sites where myointimal hyperplasia develops. In ETS, reduction of anastomosis angle will diminish flow disturbances. To reduce flow disturbances in ETE, the creation of a bulbous spatulation with resulting axial displacement of graft in relation to recipient artery should be prevented.
authors: Department of Vascular Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors: Marco
authors: M
authors: Hoedt
authors: Thien
authors: T
authors: How
authors: Paul
authors: P
authors: Poyck
authors: Cees
authors: C
authors: Wittens
mesh_terms: D000714:Anastomosis, Surgical; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D013312:Stress, Physiological; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency
references: J Vasc Surg. 1992 Apr;15(4):708-16; discussion 716-7
references: 1560562
references: Ann Biomed Eng. 2005 Mar;33(3):310-22
references: 15868721
references: Surgery. 1983 Jun;93(6):809-17
references: 6222499
references: J Biomech Eng. 1993 Feb;115(1):104-11
references: 8445887
references: J Biomech. 1996 Jul;29(7):855-72
references: 8809616
references: Proc Inst Mech Eng H. 1999;213(1):1-4
references: 10087899
references: J Biomech Eng. 2001 Jun;123(3):277-83
references: 11476372
references: J Biomech Eng. 2005 Dec;127(7):1087-98
references: 16502651
references: Eur J Vasc Endovasc Surg. 2001 Jun;21(6):520-8
references: 11397026
references: Eur J Vasc Endovasc Surg. 2003 Oct;26(4):357-66
references: 14511996
references: J Biomech Eng. 1991 Nov;113(4):458-63
references: 1762444
references: Physiol Rev. 2011 Jan;91(1):327-87
references: 21248169
references: Eur J Vasc Endovasc Surg. 2001 Mar;21(3):251-60
references: 11352685
references: Arch Surg. 1980 Nov;115(11):1280-4
references: 7436722
references: J Vasc Surg. 1995 Mar;21(3):460-71
references: 7877228
references: Ann Thorac Cardiovasc Surg. 2007 Oct;13(5):322-30
references: 17954989
references: Eur J Vasc Endovasc Surg. 2003 Dec;26(6):649-56
references: 14603426
references: Eur J Vasc Endovasc Surg. 2005 May;29(5):457-62
references: 15966083
references: J Biomech. 2004 Jul;37(7):1043-51
references: 15165874
references: Proc Inst Mech Eng H. 1999;213(5):401-9
references: 10581967
references: J Vasc Surg. 2000 May;31(5):1008-17
references: 10805893
references: J Vasc Surg. 1997 Apr;25(4):637-46
references: 9129618
references: Med Biol Eng Comput. 1992 Jul;30(4):413-8
references: 1487942
references: Eur J Vasc Endovasc Surg. 2001 Mar;21(3):266-70
references: 11352686