Vincent J. Santo, Phong Dargon, Gregory J. Landry, Timothy K. Liem, Erica L. Mitchell, Amir F. Azarbal, Gregory L. Moneta
General Surgery, Oregon Health & Science University, Portland, OR.
OBJECTIVES: Determine intervention rates, failure mechanisms, patency, wound complications and limb salvage after lower extremity revascularization using open (OVH) versus endoscopic vein harvest (EVH).
METHODS: Single institution review of consecutive patients between 2005-2012, who underwent infrainguinal bypass with reversed greater saphenous vein (GSV).
RESULTS: Three hundred twelve patients underwent revascularization; 194 with open and 118 with endoscopic GSV harvest. There were no differences between groups in age, medical co-morbidities, smoking status, prior interventions, treatment indication (CLI: 81% OVH, 83% EVH) or proximal /distal anastomotic site. Mean operative times were 262 minutes for OVH and 323 minutes for EVH (p<0.001). Mean follow-up was 556 days (OVH) and 595 days (EVH). Eighteen percent of OVH grafts and 28% of EVH grafts had an intervention during follow-up (p=0.048). Median time to intervention was 201 days (OVH) vs. 126 days (EVH) (p=0.192). Amongst interventions, there was no difference in the number that were surgical: 51.4% (OVH) vs. 63.6% (EVH) (p=0.337). Mean number of stenoses treated per intervention was 1.1 (OVH) vs. 1.2 (EVH) (p=0.552). Median stenosis length was 2.1 cm (OVH) vs. 2.6 cm (EVH) (p=0.724). Three-year primary patency was 51% (OVH) vs. 41% (EVH) (p=0.057). Secondary patency at three years was 72% (OVH) vs. 63% (EVH) (p=0.325). Overall and harvest related wound complications were 44.8% and 28% (OVH) vs. 33.9% and 10.8% (EVH) (p=0.059 and p<0.001). Limb salvage for CLI was 88.9% (OVH) and 91.2% (EVH) at 3 years (p=0.646).
CONCLUSIONS: OVH and EVH have similar long-term patency, failure mechanisms and limb salvage. Harvest related wound complications are less with EVH but overall wound complications are similar and operative times are longer for EVH and more interventions are required for EVH to maintain patency. Open GSV harvest is preferred to EVH for infrainguinal reconstructions in a predominantly CLI population.
AUTHOR DISCLOSURES: A. F. Azarbal: Nothing to disclose; P. Dargon: Nothing to disclose; G. J. Landry: Nothing to disclose; T. K. Liem: Nothing to disclose; E. L. Mitchell: Nothing to disclose; G. L. Moneta: Nothing to disclose; V. J. Santo: Nothing to disclose.
Posted April 2013