Endoscopic vein harvest for infrainguinal arterial bypass

Abstract

Background: Endoscopic harvest of saphenous vein for infrainguinal arterial bypass decreases incision length and was initially documented to decrease wound complications without adversely affecting patency. However, recent studies have shown lower patency without a wound complication benefit. We sought to further define the wound complication and patency rates of endoscopic harvest compared with open harvest in infrainguinal arterial bypass procedures.

Methods: Infrainguinal bypasses performed from 2000 to 2011 were analyzed. Only procedures using a single segment of great saphenous vein were included. Cases were grouped according to endoscopic or open harvest and were frequency-matched for body mass index and diabetes. Baseline characteristics were compared. Univariate and multivariate analysis was performed to determine correlation of baseline data and harvest method on wound complications and patency.

Results: The study included 76 bypasses; 35 in the endoscopic harvest group and 41 in the open harvest group. Baseline characteristics between the endoscopic and open harvest groups were not significantly different, with the exception of mean age, which was older in the endoscopic harvest group, and carotid artery disease, which was more common in the open harvest group. There was no significant difference between endoscopic and open harvest in 30-day wound complication rates (29% vs 27%; P = .87) or in the other perioperative variables, aside from decreased narcotic use in the endoscopic harvest group (P = .01). Mean follow-up was 747 days. There was no significant difference in 3-year primary (47% vs 49%; P = .8), 3-year primary-assisted (88% vs 73%; P = .1), or secondary patency rates (92% vs 76%; P = .09) at 3 years between the endoscopic and open harvest groups. High body mass index improved primary patency in the endoscopic harvest group (P = .02), but had no effect on patency in the open harvest group (P = .15). Patients requiring hemodialysis had increased risk for loss of primary assisted patency in both groups (endoscopic, P = .02; open, P = .02) and decreased secondary patency in the open harvest group (P = .04).

Conclusions: Endoscopic and open harvest techniques for infrainguinal arterial bypass provide similar rates of wound complications and bypass patency, whereas hemodialysis negatively affects patency after both harvest methods. Endoscopic harvest is associated with the need for less perioperative narcotics, suggesting a potential benefit of endoscopic harvest that deserves further study.