Dunn D A, Downs A R, Lye C R
Can J Surg. 1982 Jul;25(4):382-4.
Between 1968 and 1979, 192 aortofemoral bifurcation grafts were placed for aortoiliac occlusive disease. The proximal anastomosis was end-to-end in 101 and end-to-side in 91 patients. Anastomoses were end-to-end in 38 (37%) of 104 patients from 1968 to 1976 and 63 (72%) of 88 patients from 1977 to 1979. Embolization occurred intraoperatively in four end-to-end and five end-to-side anastomoses. The grafts became occluded in the early postoperative period in two patients with end-to-end proximal anastomoses. There were two aortoduodenal fistulas, both associated with end-to-side proximal anastomosis. The cumulative patency rate at 5 years was 87% for end-to-end and 85% for end-to-side anastomoses. An end-to-end proximal anastomosis is indicated for associated aneurysmal disease or in the presence of aortic occlusion, while an end-to-side anastomosis is indicated when there are low-lying accessory renal arteries or in the presence of occlusive disease in the external iliac arteries. The author's experience suggests that there is no difference in the incidence of intraoperative embolization or late occlusion between end-to-side and end-to-end proximal anastomosis. The incidence of aortoduodenal fistula appears to be lower with end-to-end proximal anastomosis possibly because of better tissue apposition at the anastomosis.
1968年至1979年间，为治疗主髂动脉闭塞性疾病共进行了192例主股动脉分叉移植术。101例患者的近端吻合采用端端吻合，91例采用端侧吻合。1968年至1976年的104例患者中有38例（37%）采用端端吻合，1977年至1979年的88例患者中有63例（72%）采用端端吻合。术中栓塞发生在4例端端吻合和5例端侧吻合中。2例近端采用端端吻合的患者术后早期移植血管闭塞。发生了2例主动脉十二指肠瘘，均与近端端侧吻合有关。端端吻合5年的累积通畅率为87%，端侧吻合为85%。近端端端吻合适用于合并动脉瘤性疾病或存在主动脉闭塞的情况，而端侧吻合适用于存在低位副肾动脉或髂外动脉存在闭塞性疾病的情况。作者的经验表明，近端端侧吻合和端端吻合在术中栓塞或晚期闭塞的发生率上没有差异。近端端端吻合时主动脉十二指肠瘘的发生率似乎较低，可能是因为吻合处组织对合更好。
