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Endoscopic Vein Harvest Versus Open Vein Harvest For Distal Revascularization And Interval Ligation
Jordan T. Kuhlman, BS1, Samantha Hopper, BS
1, Ahmad Lambert, BS
1, Jerry Liu, BSA
1, Olivia Simmons
1, Chandler Vernon
1, Kofi Quaye, MD
2, John Politz, MD
2, Ryan Turley, MD
1.
1Texas A&M Naresh K. Vashisht College of Medicine, Round Rock, TX, USA,
2Cardiothoracic and Vascular Surgeons Texas, Austin, TX, USA.
Objectives: Distal revascularization interval ligation (DRIL) is an effective surgical treatment for dialysis-associated steal syndrome (DASS). The great saphenous vein (GSV) is the most common conduit for DRIL and is traditionally harvested by open vein harvest (OVH), which carries significant risk of wound complications. To mitigate these risks, we utilized endoscopic vein harvesting (EVH) of the GSV as a conduit for DRIL procedures. This study reports our experience, specifically examining 30-day wound complications and 1-year hemodialysis access patency.
Methods: One hundred thirteen DRIL procedures were reviewed from 2012 to 2024. The cohort included 14 vascular surgeons in 8 hospitals. Data was collected by chart review with IRB approval. The primary end points were 30-day surgical wound complications and 1-year hemodialysis access patency. Secondary end points included 30-day morbidity and mortality, length of operation, and length of hospitalization.
Results: In our sample of 113 patients undergoing DRIL procedure, 81 patients used GSV, and 32 patients used alternative conduits. The hemodialysis access treated with DRIL included 72 brachiocephalic fistulas, 26 brachiobasilic transpositions, and 15 arteriovenous grafts. Of the 81 DRIL procedures using GSV, 56 were harvested with EVH and 25 were harvested with OVH. In this sample, DRIL with EVH had less reported 30-day postoperative morbidity and mortality outcomes (
n=4
vs
n=7, p=.528) and 1-year thrombotic events compared to OVH (
n=7 vs
n=9, p=.788). The EVH group trended towards shorter operative times than OVH (116 minutes vs 133 minutes, p two-tailed = 0.08, p one-tailed = 0.04*). EVH had a similar length of hospitalization compared to OVH (.964 days vs 1.25 days, p=.502). DRIL with EVH reported no wound complications 30-days postoperatively while DRIL with OVH had two reported wound complications. Primary patency, Primary-assisted patency, and Secondary patency rates were 59.62%, 75%, and 94.23%, respectively, at 1 year for EVH and mirrored those seen with OVH (Table).
Conclusions: DRIL with EVH of the GSV is an effective treatment option for DASS, offering a less invasive approach to conduit harvest. EVH for DRIL demonstrated favorable outcomes, with low incidence of wound complications and successful preservation of AV fistula patency, without extending operative times.
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