Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass

Abstract

ObjectiveConflicting data exist on outcomes of open vein harvest (OVH) and endoscopic vein harvest (EVH) for infrainguinal bypass. The purpose of this study was to compare outcomes between OVH and EVH in femoral to popliteal artery bypasses. MethodsA retrospective review was performed of all patients undergoing common femoral to popliteal artery bypass with great saphenous vein between January 1997 and June 2014. Bypasses using arm or composite vein were excluded, as were those performed for popliteal artery aneurysms or trauma. Harvest was typically performed by dedicated surgical assistants. Patients were analyzed by either OVH or EVH of vein. The primary outcome was primary patency. Secondary outcomes included assisted primary and secondary patency and major wound complications. Statistical analysis was performed for categorical and continuous variables with life-table and survival statistics for long-term outcomes. ResultsIn the study time, 505 patients underwent femoral-popliteal bypass; 262 patients and 280 limbs met the inclusion criteria. OVH was performed on 194 (69%) limbs and EVH on 86 (31%). There was no significant difference between the groups in terms of demographics, comorbidities, and preoperative Rutherford classification. Mean follow-up was 34 months. Six of 13 operators (46%) used both harvest techniques. At 5 years, OVH demonstrated higher rates of primary patency compared with EVH (62.8% vs 47%; P = .006) and higher rates of assisted primary patency (81.2% vs 64.3%; P = .003). Secondary patency was not significantly different between groups. The average number of graft interventions was less frequent with EVH, although this trend was not statistically significant (0.1 OVH vs 0.3 EVH; P = .1). EVH also had a lower rate of major wound complications per limb (n = 16; 8% OVH vs 0% EVH; P = .004). ConclusionsOVH was associated with superior primary and assisted primary patencies compared with EVH at 5 years, yet OVH was associated with higher wound complications. Surgeons should weigh the risk of wound complications vs decreased primary and primary assisted patency when deciding which method to use for vein harvest.