Encouraging Results With Endoscopic Vein Harvest For Infrainguinal Bypass

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Luke S. Erdoes, MD, Timothy P. Milner, MD.
University of Tennessee, Chattanooga, TN, USA.

BACKGROUND: Wound complications after infrainguinal vein bypass remain a significant source of morbidity. Endoscopic saphenous vein harvest has emerged as a viable alternative to minimize vein harvest incisions.
METHODS: Infrainguinal bypass using an endoscopic vein harvest was performed in 214 limbs in 198 consecutive patients between May 1998 and July 2004. The indication for bypass was limb salvage in 88.3%, claudication in 9.3% and other in 2.4%. Atherosclerotic risk factors were prevalent with diabetes in 68%, and dialysis dependent renal failure in 11.7%.
RESULTS: The procedure was successful in all but one patient although several required small incisions to ligate large or missed branches. Ipsilateral greater saphenous vein was utilized in 89.7%, contralateral greater saphenous vein in 8.4%, and lesser saphenous vein in 1.9%. Two injuries to the main trunk of the vein occurred early in the series. Assisted primary patency at a mean follow-up of 18 months (range 1 - 48 months) is 76.1% by life table analysis. For patients with claudication, rest pain, or minimal gangrene, the average length of stay was 3 days (range 1 - 6 days). Wound complications occurred in 16 patients (7.5%), 10 of these requiring only local care (class 1 and 2), and 6 deep wounds threatening the leg or graft (class 3). Only 5 patients, all with class 3 wounds, required readmission to the hospital for graft related problems. The endoscopic kit costs about $700.00, but there is no increase in operating room time once the learning curve is overcome. Patient satisfaction is very high.
CONCLUSION: Endoscopic saphenous vein harvest is a useful adjunct to infrainguinal vein bypass and likely decreases the hospital length of stay, wound complications, and hospital readmission rates. Endoscopic vein harvest may become the procedure of choice for vein procurement for infrainguinal bypass procedures.