Endoscopic vs Open Saphenous Vein Harvest for Femoral to Below the Knee Arterial Bypass Using Saphenous Vein Graft

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Leo M. Gazoni, MD, Rebecca L. Carty, BS, Nancy L. Harthun, MD, Kenneth J. Cherry, MD, Curtis G. Tribble, MD, Irving L. Kron, MD, John A. Kern, MD.
University of Virginia, Charlottesville, VA, USA.

BACKGROUND:
While the use of endoscopic vein harvest (EVH) in coronary artery bypass grafting is accepted, few studies to date have looked at the implementation of EVH in peripheral vascular disease surgery. We hypothesize that EVH improves outcomes compared to OVH in patients undergoing femoral to below the knee arterial bypass surgery.
METHODS:
The charts of 144 consecutive patients undergoing infrainguinal bypass surgery over the course of a 27 month period were reviewed. 88 patients underwent a femoral to below the knee arterial bypass. Twenty-nine patients had an EVH for a femoral to below the knee arterial bypass. Pre-operative characteristics were evaluated including age, sex, renal function, history of diabetes, hypertension, tobacco use, and previous infrainguinal bypass surgery on the affected side. Endpoints included wound complications, length of hospital stay, operative time, and angiographic and operative interventions within 1 year of the bypass surgery.
RESULTS:
Patient characteristics and demographics were similar in both EVH and OVH groups. The EVH group required fewer operative interventions for occlusion in the first 12 post-operative month (0/29, 0%) compared to the OVH group (8/51, 13.4%) (p=0.03). The primary patency rate was 89.7% in the EVH group and 76.3% in the OVH group (p=0.14).No significant differences were found between the EVH and OVH groups with regard to wound complications (p=0.68), length of hospital stay (p=0.87), operative time (p=0.11), acute intervention in the immediate post-operative period (p=.80), and amputations within 1 year of the bypass surgery (p=0.56).
CONCLUSIONS:
Despite initial concerns of damaging the venous conduit with a minimally invasive approach, EVH has demonstrated a trend toward increased primary patency rates at 12 months while also providing improved cosmesis. An endoscopic approach affords the benefits of smaller incisions, decreased operative interventions for occlusion at 1 year, and otherwise comparable outcomes with OVH thereby making EVH the procedure of choice in harvesting saphenous vein for femoral to below the knee arterial bypass surgery.

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