A numerical simulation of the steady and pulsatile flow across the end-to-side anastomosis was performed In order to understand the role of flow dynamics in the preferential bevel opment of distal anastomotic intimal hyperplasla. The finite element technique was employed to solve two-dimensional unsteady pulsatile flow in that region. The results of the steady flow revealed that low shear stresses occur at the proximally occluded host artery and at the recirculation region in the Inner wall just distal to the toe region of the anastomosis. The nor- mal;zed wall shear rate was increased, as was the recirculation zone size in the host artery of the by-pass graft anastomosis, with increased anastomotic junction angle. In order to min imize the size of the low wall shear region which might result in the intimal hyperplasia in the by-pass graft anastomosis, a smaller anastomotic junction angle is recommended. The pulsatile flow simulation revealed flow that regions of low and ascillating mali shear do exist near the anastomosis as In the steady simulation. The shift of stagnation point depends on the pulsation of the flow. As the flow was accelerated at systole, the stagnation point moved downstream, disappered at early diastole and reappeared during late diastole. Low shear stress was also found along both walls of the occluded proximal artery. However, the diastolic flow behavior is quite different from the steady results. The vortex near the occluded artery moved downstream and inwardly during late systole, and disappeared during diastole. Recirculations proximal to the toe and heel regions were significant during diastole. Shear stress oscillation was found along the opposite wall. The results of the present study revealed that tow shear occurs at the proximally occluded host artery aud the recirculation region in the inner wall Just dlstal to the toe region of the anastomosis. The present study suggested that the regions of fluctuated wall shear stress wit flow separation is correlated with the preferential developing regions of anastomosis neointial fibrous hyperplasia.