Open Surgical versus Minimally Invasive in Situ Femorodistal Bypass: Long-term Results

Abstract

Purpose:

To compare long-term patency and limb survival rates for the classical in situ surgical bypass procedure versus a minimally invasive technique for femorodistal revascularization.

Methods:

From May 1992 to June 1994, a prospective multicenter study was undertaken at 4 centers to evaluate the open versus closed technique for femorodistal bypass grafting. Of 97 patients enrolled in the trial, 73 patients (49 men; mean age 71 years) were assigned to the long-term follow-up protocol and prospectively randomized to the open (n = 38) or closed (n = 35) procedure. The classical open technique is characterized by a long incision over the length of the bypass graft, while the minimally invasive procedure involves only two short incisions over each anastomosis site (the side branches are closed with a coaxial embolization catheter system). Graft patency was evaluated with duplex imaging periodically throughout the 4-year observation period.

Results:

There was no statistically significant difference between the treatment groups with respect to age, sex, hypertension, ischemic heart disease, or smoking. However, the open group had a significantly greater incidence of diabetes (p = 0.037). Over a median 4.7-year follow-up (range 0.3–6.4), 9 (12%) patients (3 open and 6 closed) were lost to follow-up: 2 died and 7 refused the duplex examination. No significant differences in 4-year patency, limb salvage, or survival was demonstrated between the open versus closed treatment groups; 4-year secondary patency was 62% versus 64%, respectively, and limb salvage was 72% versus 86%.

Conclusions:

The closed technique for femorodistal in situ bypass procedures yields favorable long-term outcomes compared to the traditional open technique.

Keywords

occlusive disease in situ femorodistal bypass greater saphenous vein graft patency limb salvage outcome analysis

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References

Hall

. The great saphenous vein as an arterial shunt after extirpation of the vein valves. Surgery. 1962;51:492–495.

Lemaitre

. In Situ Bypass Grafting. Andover, MA: Vascutech, Inc.; 1987.

Archer

Turnipseed

. In situ distal saphenous vein bypass using the intraluminal valve disruption technique. Arch Surg. 1985;120:933–939.

van Dijk

van Urk

du Bois

. A new closed in situ vein bypass technique results in a reduced wound complication rate. Eur J Vasc Surg. 1995;10:162–167.

Wittens

van Dijk

du Bois

. A new closed in situ vein bypass technique. Eur J Vasc Surg. 1994;8:166–177.

van Dijk

Seerden

van Urk

. Comparison of cost affecting parameters and costs of the closed and open in situ bypass technique. Eur J Vasc Endovasc Surg. 1997;13:460–463.

van Dijk

van Urk

Lameris

. Residual arterio-venous fistulas after closed in situ bypass grafting: an overrated problem. Eur J Vasc Endovasc Surg. 1997;13:439–442.

Nelson

Arous

. Endovascular in situ bypass decreases morbidity and hospital stay following infrainguinal arterial reconstruction. J Endovasc Ther. 2000;7:309–314.

Nelson

McEnaney

Callahan

. Impact of endovascular-assisted in situ saphenous vein bypass technique on hospital costs. Ann Vasc Surg. 2001;15:653–660.

10.

Rosenthal

Arous

Friedman

. Endovascular-assisted versus conventional in situ saphenous vein bypass grafting: cumulative patency, limb salvage, and cost results in a 39-month multicenter study. J Vasc Surg. 2000;31:60–68.