Exclusion Bypass in Peripheral Vascular Surgery

Although the technique of end-to-end proximal aortic anastomosis for peripheral bypass surgery has been widely accepted, the distal exclusion of the proximal native circulation has not been given much attention. Experimentally it has been shown that an end-to-end anastomosis at the distal end of the bypass graft has better hemodynamics and flows than an end-to-side. A group of 20 patients are reported here in whom a total exclusion bypass was carried out proximal and distally. One single case of aorto bifemoral is reported, 6 ileo-femoral, 12 femoro-popliteal, and 1 femoro-femoral bypass. Gortex grafts were used in all instances. Blood flows measured beyond the distal anastomosis show an increase in flow after the proximal native vessel is excluded completely at the distal anastomotic site. This technique, therefore, is advocated and recommended over the classic proximal and distal end-to-side anastomosis for ileo- femoral and femoro-popliteal bypass reconstructions.