End-to-end Versus End-to-side Distal Anastomosis in Femoropopliteal Bypasses; Results of a Randomized Multicenter Trial

Abstract

Objective To compare end-to-side (ETS) and end-to-end (ETE) distal anastomoses for femoropopliteal bypasses. Design Prospective, randomized, multicenter trial. Methods Patients from 14 centers were randomized to either ETS or ETE distal anastomosis, with stratification according to center and four categories: venous and prosthetic above knee bypass, and venous and prosthetic below knee bypass. Follow-up, with history, physical examination, ankle-brachial pressure index and duplex scan was performed at 3 months, 6 months and every 6 months thereafter until 36 months postoperatively. Results A total of 328 femoropopliteal bypass operations were performed in 274 patients. Due to anatomical considerations at the time of surgery, 15 procedures (4.6%) were excluded from further analysis. Patient characteristics, cardiovascular risk factors, Rutherford classification and number of open run-off vessels were similar for both groups. Primary patency was 75 vs 74%, 65 vs 66% and 63 vs 55% for ETE vs ETS after 1, 2 and 3 years, respectively, ( p=0.26). During follow up major amputations were necessary in 20 ETE bypasses and in nine ETS bypasses ( p=0.028). Conclusion ETE distal anastomosis in femoropopliteal bypasses does not improve patency compared to ETS anastomosis. Major amputations, after failure of the bypass, were required more frequently for ETE distal anastomoses.