Hemodynamic Principles and End-to-Side Vascular Anastomoses

Bypass angioplastic procedures based on the technique originally described by Kunlin⁴ with autologous vein grafts and more recently by Linton and Menendez⁶ and Crawford and De Bakey² with arterial homografts and plastic prostheses are extensively used by the vascular surgeon on the treatment of segmental vascular occlusions. They allow the preservation of an already established collateral circulation and also prevent further damage to the blood supply of a limb in the event of graft failure.

This technique has demonstrated the values of the end-to-side vascular anastomosis when an end-to-end suture is not feasible and emphasized the importance of determining the best hemodynamic conditions to prevent blood flow reduction or late thrombosis.

It is recognized that due to the mechanical characteristics of the normal arterial wall and variations on the pressure head and physical properties of the blood, general principles of fluid flow cannot be directly applied to