Evaluation of end-to-side v end-to-end proximal anastomosis in aortobifemoral bypass
G. E. Pierce, M. Turrentine, S. Stringfield, J. Iliopoulos, C. A. Hardin, A. S. Hermreck and J. H. Thomas
The cumulative graft-limb patency rate was significantly higher after
aortobifemoral bypass with a proximal end-to-end anastomosis (E-E-AN) than
with a proximal end-to-side anastomosis (E-S-AN), 100% v 93%, respectively,
after 1.5 years in a consecutive series of 38 E-S-ANs followed by 41
E-E-ANs. The two operations were equally effective in relieving hip
claudication, but impotence occurred more frequently after E-E-AN (27%)
than after E-S-AN (13%). This difference was not significant, but six of
ten patients with E-E-AN who became impotent had arteriographic patterns
predicting that graft flow into hypogastric arteries might be compromised.
Intraoperative studies demonstrated that acute bilateral occlusion of
hypogastric arteries significantly decreases penile BP, but branches of the
external iliac arteries also contribute to penile flow and may become the
major route of supply in patients with hypogastric occlusive disease.
