Endoscopic Versus Open Saphenous Vein Graft Harvest for Lower Extremity Bypass in Critical Limb Ischemia (CLI)

Abstract

Endoscopic vein harvest (EVH) has been demonstrated to improve early morbidity compared with conventional open vein harvest (OVH) technique for infrainguinal bypass surgery. Recent literature, however, suggests conflicting results regarding long-term patency between these techniques. The purpose of this study was to compare outcomes and graft patency in patients with critical limb ischemia (CLI). This retrospective study compared 39 EVH patients and 49 OVH patients undergoing lower extremity revascularization from January 2009 to December 2011. Outcome measures included patency rates, postoperative complications, and wound infection. Graft patency was assessed using Kaplan-Meier estimation and Cox proportional hazards models. Both groups were matched demographically and for indications for bypass (CLI). Median follow-up was 22.8 months. There were differences in postoperative complications between the two groups. The incidence of wound infection at the vein harvest site was 0% in EVH vs 20% in OVH; nevertheless, the difference was not significant when all surgical sites were included (22.9% OVH, 16.2% EVH). Length of hospital stay was comparable between the two groups, although the EVH group had tendency toward quicker recovery. Primary patency rate at 1 year was 43.2% in the EVH group and 69.4% in the OVH group (P = .007). The most common reason for loss of primary patency was graft occlusion (61.5%) in the OVH group and vein body stenosis (54.5%) in the EVH group. The average number of vascular reinterventions per bypass graft was significantly lower in the OVH group (0.37) than in the EVH group (1.28; P < .001; Table).TableOutcomes among patients undergoing OVH versus EVHVariableOVHEVHPProcedures, n4939Length of hospital stay6.05 ± 3.37.14 ± 9.7.26Postoperative leg wound infection (surgical site + vein harvest site)11 (22.9%)6 (16.2%).31Major amputations (BKA/AKA)4 (8.1%)1 (2.5%).34Discharge disposition Home29 (59.1%)26 (70.3%).40 Nursing facility20 (40.8%)11 (29.7%).57Primary patency at one year69.4%43.2%.007Loss of primary patency:15 (30.6%)23 (58.9%) Anastomotic stenosis23%18% Graft occlusion61%22.7% Vein body stenosis0%54.5%Average # of interventions/graft0.37 ± 0.851.28 ± 1.59<.001 Open table in a new tab Our findings demonstrate an inferior patency, higher rates of reinterventions, with a different mode of failure in patients undergoing EVH compared with OVH. Short-term benefits of EVH, including a trend towards quicker recovery and lower rate of vein harvest site infection, appear maintained.