End-to-End versus End-to-Side Microvascular Anastomosis

A Meta-analysis of Free Flap Outcomes

Iraj Ahmadi, Pradyumna V Herle, George S. Miller, David J. Hunter-Smith, James Leong, Warren Matthew Rozen

Research output: Contribution to journalArticleResearchpeer-review

7 Citations (Scopus)

Abstract

Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53-3.21) and 1.50 (95% CI: 0.85-2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32-3.35) and 1.04 (95% CI: 0.72-1.48), respectively. Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.

Original languageEnglish
Pages (from-to)402-411
Number of pages10
JournalJournal of Reconstructive Microsurgery
Volume33
Issue number6
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • anastomosis
  • arterial
  • artery
  • free flap
  • microsurgery
  • venous

Cite this

@article{ac6293e4d7124fd1a43218b5048095d9,
title = "End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes",
abstract = "Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95{\%} confidence interval [CI]: 0.53-3.21) and 1.50 (95{\%} CI: 0.85-2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95{\%} CI: 0.32-3.35) and 1.04 (95{\%} CI: 0.72-1.48), respectively. Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.",
keywords = "anastomosis, arterial, artery, free flap, microsurgery, venous",
author = "Iraj Ahmadi and Herle, {Pradyumna V} and Miller, {George S.} and Hunter-Smith, {David J.} and James Leong and Rozen, {Warren Matthew}",
year = "2017",
month = "7",
day = "1",
doi = "10.1055/s-0037-1599099",
language = "English",
volume = "33",
pages = "402--411",
journal = "Journal of Reconstructive Microsurgery",
issn = "0743-684X",
publisher = "Thieme Publishing",
number = "6",

}

End-to-End versus End-to-Side Microvascular Anastomosis : A Meta-analysis of Free Flap Outcomes. / Ahmadi, Iraj; Herle, Pradyumna V; Miller, George S.; Hunter-Smith, David J.; Leong, James; Rozen, Warren Matthew.

In: Journal of Reconstructive Microsurgery, Vol. 33, No. 6, 01.07.2017, p. 402-411.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - End-to-End versus End-to-Side Microvascular Anastomosis

T2 - A Meta-analysis of Free Flap Outcomes

AU - Ahmadi, Iraj

AU - Herle, Pradyumna V

AU - Miller, George S.

AU - Hunter-Smith, David J.

AU - Leong, James

AU - Rozen, Warren Matthew

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53-3.21) and 1.50 (95% CI: 0.85-2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32-3.35) and 1.04 (95% CI: 0.72-1.48), respectively. Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.

AB - Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53-3.21) and 1.50 (95% CI: 0.85-2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32-3.35) and 1.04 (95% CI: 0.72-1.48), respectively. Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.

KW - anastomosis

KW - arterial

KW - artery

KW - free flap

KW - microsurgery

KW - venous

UR - http://www.scopus.com/inward/record.url?scp=85014544196&partnerID=8YFLogxK

U2 - 10.1055/s-0037-1599099

DO - 10.1055/s-0037-1599099

M3 - Article

VL - 33

SP - 402

EP - 411

JO - Journal of Reconstructive Microsurgery

JF - Journal of Reconstructive Microsurgery

SN - 0743-684X

IS - 6

ER -