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Endoscopic verus open saphenous vein harvesting for femoral to popliteal artery bypass
Aleem K. Mirza, MD, Kendall Stauffer, Mark D. Fleming, M.D., Randall R. De Martino, M.D., Gustavo S. Oderich, M.D., Manju Kalra, MBBS, Audra A. Duncan, M.D., Peter Gloviczki, M.D., Thomas C. Bower, M.D..
Mayo Clinic, Rochester, MN, USA.
Objectives
Conflicting data exists on outcomes of open vein harvest (OVH) and endoscopic vein harvest (EVH) for infra-inguinal bypass. The purpose of this study is to compare outcomes between OVH and EVH in femoral to popliteal artery bypasses.
Methods
A 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. Patients were analyzed by either EVH or OVH of vein for bypass. The primary outcome was primary patency. Secondary outcomes included primary-assisted 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.
Results
505 patients underwent femoral-popliteal bypass in the study time. 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 pre-operative Rutherford classification. Mean follow up was 34 months. Primary patency was 83%, 72%, 68% and 63% at 1, 2, 3, and 5 years for OVH versus 61%, 57%, 53%, and 49% for EVH at the same time intervals with significantly higher patency for OVH at one year (p=0.009) but non significant at 5 years (p=0.4). Similarly, primary-assisted patency for OVH was 91%, 86%, 85%, and 81% at 1, 2, 3, and 5 years compared to 75%, 71%, 66% and 66% for EVH at five years with OVH having higher primary-assisted patency at one year (p=0.01). Secondary patency was similar between groups at 92%, 88%, 87%, and 83% for OVH and 85%, 80%, 75%, and 75% for EVH at 1, 2, 3, and 5 years (p>0.05). EVH had a higher number of average graft interventions (0.1 OVH vs. 0.3 EVH, p=0.04), and a lower rate of major wound complications (n=16, 8.2% OVH vs. 0% EVH, p=0.006).
Conclusions
OVH was associated with superior primary and primary-assisted patencies compared to EVH at one year, yet OVH was associated with higher wound complications. There was a trend towards improved outcomes in OVH in longer follow-up.
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