Madiba T E, Mars M, Robbs J V
Vascular Service, University of Natal, Durban, South Africa.
Br J Surg. 1997 Oct;84(10):1416-8.
The preferred method of proximal aortic anastomosis (end to end or end to side) in aortobifemoral bypass remains controversial.
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.
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.
End-to-end anastomosis yields significantly better results than end-to-side anastomosis irrespective of distal run-off.
在主动脉双股动脉旁路移植术中，近端主动脉吻合的首选方法（端端吻合或端侧吻合）仍存在争议。
本研究纳入了492例因主髂动脉疾病在9年内接受主动脉双股动脉旁路移植术的患者，比较了端端吻合（166例患者）和端侧吻合（326例患者）的近端主动脉吻合情况。吻合方式的选择在手术时根据主动脉疾病的严重程度决定。结果与近端吻合部位和远端血流情况相关。
围手术期总死亡率为5%。端侧吻合组有6例患者出现早期移植物闭塞，端端吻合组无此情况。随访期间，端端吻合术后有9例患者（5%）出现移植物闭塞，端侧吻合术后有56例患者（17%）出现移植物闭塞（累积通畅率分别为87%和75%）。通畅率不受远端血流情况的影响。
无论远端血流情况如何，端端吻合的效果明显优于端侧吻合。
