Ten-year experience of infrainguinal bypass with endoscopic vein harvest

Abstract

Objectives

There is conflicting data comparing minimally invasive vein harvest (MIVH) using endoscopic technique and open vein harvest (OVH) in terms of bypass patency, wound infection incidence, and patient morbidity. Our institution has performed MIVH since 2003 for peripheral bypass procedures with a consistent team of specialized endoscopic vein harvesters. This study reviewed the major outcomes of MIVH infrainguinal bypass at our institution given a predominant cohort of critical limb ischemia.

Methods

We performed a 10-year, retrospective, single-institution review from January 2005 to December 2014, identifying all patients undergoing MIVH for obstructive infrainguinal disease. Primary outcomes were primary patency, operative time, intraoperative complications, surgical site infection (SSI), and freedom from amputation.

Results

A total of 289 patients (70% male) underwent MIVH infrainguinal bypass at an average age of 68 ± 12 years old, an obesity prevalence of 28%, and with critical limb ischemia in 81% of the patient cohort (20% rest pain, 61% tissue loss/gangrene). Ninety-four percent of patients had no intraoperative complications, 2.5% had adverse cardiac or technical complications, and 4.2% of patients required transfusion. Average operative time was 4.2 h. Femoral-popliteal TASC classification C and D constituted 80% of our patient cohort. At the last follow-up, toe pressures had increased from 30 ± 30 to 62 ± 40 mmHg (p < 0.0001). Primary bypass patency in the first 30 days was 95%. SSI incidence requiring surgical treatment was only 6%. Our median length of stay was 4.0 days, with median intravenous narcotic use of 1 day. In addition, 77% of patients returned to their baseline mobility at first follow-up (median 19 days), and 83% of patients had freedom from amputation at last follow-up (median 820 days).

Conclusions

In a center with experience in MIVH and a consistent group of experienced endoscopic vein harvesters, MIVH bypass has excellent patency, low surgical site infection, short length of stay, and prompt return to baseline mobility.

Keywords

Minimally invasive endoscopic vein harvest lower extremity bypass leg bypass

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References

Allen

Griffith

Heimansohn

, et al. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg 1998; 66(1): 26–31.

Black

Campbell

Channon

, et al. Minimally invasive vein harvesting significantly reduces pain and wound morbidity. Eur J Cardiothorac Surg 2002; 22(3): 381–386.

Galbraith

Pica-Furey

. A retrospective comparative study of open and endoscopic saphenous vein harvesting. J Endovasc Ther 2000; 7(6): 460–468.

Eid

Wang

Kuzman

, et al. Endoscopic versus open saphenous vein graft harvest for lower extremity bypass in critical limb ischemia. J Vasc Surg 2014; 59(1): 136–144.

Gazoni

Carty

Skinner

, et al. Endoscopic versus open saphenous vein harvest for femoral to below the knee arterial bypass using saphenous vein graft. J Vasc Surg. 2006; 44(2):282–287.

Illig

Rhodes

Sternbach

, et al. Financial impact of endoscopic vein harvest for infrainguinal bypass. J Vasc Surg. 2003; 37(2):323–330.

Illig

Rhodes

Sternbach

, et al. Reduction in wound morbidity rates following endoscopic saphenous vein harvest. Ann Vasc Surg 2001; 15(1): 104–109.

Jauhari

Hughes

Black

, et al. Endoscopic vein harvesting in lower extremity arterial bypass: a systemic review. Eur J Vasc Endovasc Surg 2014; 47(6): 621–639.

Jordan

Jr Alcocer

Voellinger

, et al. The durability of endoscopic saphenous vein grafts: a 5-year observational study. J Vasc Surg 2001; 34(3): 434–439.

10.

Julliard

Katzen

Nabozny

, et al. Long-term results of endoscopic versus open saphenous vein harvest for lower extremity bypass. Ann Vasc Surg 2011; 25(1): 101–107.

11.

Lai

Babb

Ning

, et al. The transition from open to endoscopic saphenous vein harvesting and its clinical impact: The Texas heart institute experience. Tex Heart Inst J 2006; 33(3): 316–320.

12.

Santo

Dargon

Azarbal

, et al. Open versus endoscopic great saphenous vein harvest for lower extremity revascularization of critical limb ischemia. J Vasc Surg 2014; 59(2): 427–434.

13.

Wartman

Woo

Herscu

, et al. Endoscopic vein harvest for infrainguinal arterial bypass. J Vasc Surg 2013; 57(6): 1489–1494.

14.

Mirza

Stauffer

Fleming

, et al. Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass. J Vasc Surg 2018; 67(4): 1199–1206.

15.

Kronick

Liem

Jung

, et al. Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses. J Vasc Surg 2019; 70(5): 1534–1542.

16.

Goodney

Likosky

Cronenwett

. Predicting ambulation status one year after lower extremity bypass. J Vasc Surg 2009; 49(6): 1431–1439.

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