Choosing the proximal anastomosis in aortobifemoral bypass.

BACKGROUND: The preferred method of proximal aortic anastomosis (end to end or end to side) in aortobifemoral bypass remains controversial.

METHODS: This is a study of 492 patients who had an aortobifemoral bypass for aortoiliac disease over 9 years in which end-to-end (166 patients) and end-to-side (326 patients) proximal aortic anastomoses were compared. The decision as to the type of anastomosis was made at operation, depending on the severity of aortic disease. Outcome was related to the site of the proximal anastomosis and the state of the distal run-off.

RESULTS: The overall perioperative mortality rate was 5 per cent. Early graft occlusion occurred in six patients in the end-to-side group and none in the end-to-end group. During follow-up nine patients (5 per cent) had graft occlusion following end-to-end anastomosis and 56 (17 per cent) following end-to-side anastomosis (cumulative patency 87 and 75 per cent respectively). Patency was not affected by the distal run-off.

DISCUSSION: End-to-end anastomosis yields significantly better results than end-to-side anastomosis irrespective of distal run-off.