Arterial homografts: Experience with end-to-side vascular anastomosis☆

Abstract Analysis of the short term results following end-to-side anastomosis of five arterial homografts is presented. Our immediate results indicate a high percentage of patency with excellent blood flow distally, as demonstrated by bounding peripheral pulses and postoperative arteriograms. Symptomatology of intermittent claudication, rest pain, etc., is either markedly reduced or completely eliminated. As demonstrated by one of our cases, even though the extremity may not be completely restored to normal function if gangrene is present, the level of amputation may be markedly lowered so that a digital removal can be effected instead of an above-the-knee amputation. Performance of end-to-side anastomosis preserves the collateral circulation, which is a safety factor if thrombosis of the graft occurs. It permits placement of the proximal anastomosis at a much higher level so that a greater blood flow under higher pressure is assured. By the utilization of a side of the host artery which is soft and pliable and free from atheromatous plaques, better tissue can be used to fashion the anastomosis without performing an endarterectomy. It is recommended that end-to-side anastomosis to the aorta be used for bifurcation grafts for all the foregoing reasons. Of particular importance is the preservation of essential collaterals such as those originating from the inferior mesenteric and hypogastric arteries which are usually sacrificed by replacement technics.