End-to-end versus end-to-side distal anastomosis in femoropopliteal bypasses; results of a randomized multicenter trial

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 femoropoplite al bypasses does not improve patency compared to ETS anastomosis. Major amputations, after failure of the bypass, were required more frequently for ETE distal anastomoses.

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