Experienced Operators Achieve Superior Primary Patency and Wound Complication Rates with Endoscopic Greater Saphenous Vein Harvest Compared to Open Harvest in Lower Extremity Bypasses
Gregory Landry, MD, Maxwell Davis, Helena Klein, Erica Mitchell, MD, TIMOTHY LIEM, MD, Enjae Jung, MD, Cherrie Abraham, MD, Gregory Moneta, MD.
Oregon Health & Science University, Portland, OR, USA.
OBJECTIVES: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH) vs open harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH, and that with experience, improved patency can be achieved.
METHODS: Single institution review of 113 subjects with critical limb ischemia that underwent infrainguinal bypass with a continuous segment of greater saphenous vein harvested either endoscopically (n=49) or through a single open incision (n = 64) from 2012 to 2017. EVH was performed by surgeons with > 5 years experience with this technique. Operative outcomes, patency, complications and readmission rates were compared between the harvest methods.
RESULTS: There were no significant differences in patient demographics, medications, operative indications, or inflow/ouflow vessels between the two groups. Median operative time for OVH was 290 minutes and hospital length of stay 6 days, and for EVH 316 minutes and 5 days (p=ns). Harvest related wound complications were more frequent with OVH (29% vs 12%, p=0.04). Primary patency at 1 and 2 years was 57% and 41% for OVH, and 80% and 65% for EVH (p=0.03). Assisted primary patency at the same time points was 90% and 85% for OVH, and 97% at both times for EVH (p=0.11). Thirty day readmissions were similar between the two groups (OVH 25% vs EVH 12%, p=0.3), but 90 day readmissions were more frequent in the OVH group (33% vs 14%, p=0.04).
CONCLUSIONS: With experience, lower extremity bypass using EVH can result in improved primary patency compared to OVH, while also resulting in fewer wound complications and readmissions, with comparable operative times and hospital length of stay. This technique should be more widely adopted by vascular surgeons as a primary method of vein harvest.
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