Endoscopic Vein Harvest for Infra-inguinal Arterial Bypass

Abstract

Endoscopic harvest (EH) of saphenous vein for lower extremity bypass decreases length of incisions and was initially thought to decrease wound complication rates without adversely affecting patency. However, recent studies have shown lower patency without a wound complication benefit. We sought to further study the wound complication and patency rates of EH compared with open harvest (OH) techniques in infrainguinal arterial bypass procedures. Infrainguinal bypasses performed between 2000 and 2011 were analyzed. Only procedures using a single segment of great saphenous vein were included. Patients were grouped according to EH or OH. The two groups were frequency-matched for body mass index and diabetes. Baseline characteristics were compared. Univariate and multivariate analysis was performed, as appropriate, to determine correlation of baseline data and harvest method on patency. The study included 76 bypasses: 35 in the EH group and 41 in the OH group. Baseline characteristics between the OH and EH groups were not significantly different. Mean age was 72 years in the EH group and 67 years in the OH group. The difference in the numbers of men and women between the two groups was not significant. Mean follow-up was 747 days. There was no significant difference between the EH and OH groups in 30-day wound complication rates (29% vs 27%; P = .86), 3 year primary patency rates (47% vs 49%, P = .82), or 3 year primary assisted patency rates (88% vs. 76%, P = .2). There was a trend toward increased secondary patency in the EH group (92% vs 73%, P = .053). High body mass index improved primary patency (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.82-0.97). Patients requiring hemodialysis had increased risk for loss of primary assisted patency (HR, 12.05; 95% CI 3.19-45.57) and secondary patency (HR, 5.27; 95% CI 1.60-17.34). This remained significant on multivariate analysis when accounting for type of vein harvest. Overall, EH for infrainguinal arterial bypass confers no additional benefit in wound complication or bypass patency rates compared with OH. However, the possibility that bypass patency may be enhanced by EH in the nonhemodialysis population deserves further study.