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Preliminary Experience With Endoscopic Vein Harvest Of The Greater Saphenous Vein For Infrainguinal Arterial Reconstruction
Monica A. Silva, DO, Bryan R. Foster, PA-C, Laurie M. Kuestner, MD, James L. Ebaugh, MD, Harold W. Hsu, MD, Zane Young, MD, Jose R. Borromeo, MD, Alik Farber, MD, David K. Chew, MBBS.
MercyOne Medical Center, Des Moines, IA, USA.
OBJECTIVES:The BEST-CLI trial showed superiority of bypass using greater saphenous vein (GSV) over endovascular techniques for infrainguinal revascularization in patients with chronic limb threatening ischemia. Wound complications from open vein harvest are common. Endoscopic vein harvest (EVH) is widely used in cardiac surgery, yet remains controversial in vascular surgery due to concerns regarding venous injury. The purpose of this study was to evaluate our initial experience with this harvest method.
METHODS:Consecutive patients undergoing infrainguinal bypass using the Vasoview Hemopro 2 System from June 2022 through August 2023 were prospectively followed. All patients had preoperative duplex ultrasound mapping of the GSV. Data collected included demographics, indications for procedure, operative time, vein harvest time, length of stay, wound complications, postoperative use of narcotic pain medication, and graft patency. Follow-up with duplex ultrasound and ankle brachial indices were performed at 1, 3, 6, and 9 months postoperatively.
RESULTS:36 patients (male 69%, mean age 67 yr) underwent infrainguinal bypass predominantly for limb salvage (77.8%). The proximal anastomotic site was at the femoral artery in 97.2%. Distal anastomotic sites included above knee popliteal (19.4%), below knee popliteal (27.8%), tibial arteries (50%), and plantar arteries (3%). Median vein harvest time was 53 minutes. Median narcotic use was a total of only 35 morphine mEq over a median hospital stay of 3 days. 5 patients experienced groin wound complications; no wound complications occurred from EVH sites. There were no vein injuries during harvest. Follow up at 9 months was complete in 8 of 15 patients. Primary patency at 1 month, 6 month, and 9 month follow-up was 100%, 82.3%, and 66.7%. Primary-assisted patency was 100% at all intervals. There were no graft occlusions.
CONCLUSIONS: Initial experience suggests that EVH of the GSV is a safe and technically feasible option for infrainguinal arterial reconstruction. Further investigation is ongoing to confirm long-term durability of this approach.
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