Influence of the type of anastomosis: end-to-side anastomosis versus end-to-end

The by-pass technique of arterial reconstruction has some theoretical disadvantages, particularly, unnecessary abandoning of useful main arteries, undesirable flow patterns and the possible descent of debris from the by-passed portion of artery. An oblique end-to-end technique can avoid these undesirable features and also avoid the creation of an over-sized vessel at the site of end-to-side anastomosis. It is suggested that the least procedure compatible with success should be used in arterial reconstruction in the lower limb and an ascending range of options open to the surgeon is given.