End-to-Side Anastomosis

Abstract

In most bypasses performed for occlusive disease, the proximal and distal anastomoses are constructed in an end-to-side fashion. Such a configuration allows for constructing the proximal anastomosis in the least diseased area of the inflow vessel while maintaining the original circulation. The distal anastomosis is constructed distal to any occlusive pathology and provides both antegrade and retrograde blood flow. The revascularization provided by the end-to-side configuration protects the limb from ischemia between the proximal and distal anastomoses. This condition, often referred to as “interval ischemia,” is more likely to occur when both anastomoses are constructed using an end-to-end configuration. This chapters covers the various techniques for constructing an end to side anastomosis.