To the Editor.—I read with considerable interest the article entitled "Late Thrombosis Affecting One Limb of Aortic Bifurcation Graft" (Arch Surg 110:409, 1975) in which a study was undertaken to determine the possible causes of late occlusion of aortic bifurcation grafts. In addition to the causative factors discussed in the article, there are three other possible etiologic factors to which the authors did not refer, which we believe to be of considerable importance.
It is not stated whether the proximal anastomosis was end to side to the aorta or whether the aorta was transected and an end-to-end anastomosis done. In an end-to-side anastomosis, even when considerable care is taken, kinking at the origin of the limb of the prosthesis to the body of the graft may occur, which may predispose to graft occlusion. This has been shown by others1 and ourselves.2 We believe that wherever possible, the
GAYLIS H. Late Thrombosis. Arch Surg. 1975;110(9):1155-1156. doi:10.1001/archsurg.1975.01360150099024