Endoscopic harvest of great saphenous vein for infrainguinal arterial bypass: summary of our initial experience
Authors:
E. Biroš 1; R. Staffa 1; R. Vlachovský 1; T. Novotný 1; E. Janoušová 2
Authors place of work:
II. chirurgická klinika, Centrum cévních onemocnění, FN u sv. Anny v Brně a LF Masarykovy univerzity
přednosta: prof. MUDr. R. Staffa, Ph. D.
1; Institut biostatistiky a analýz, Lékařská fakulta Masarykovy univerzity
ředitel: doc. RNDr. L. Dušek, Ph. D.
2
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 3, s. 117-122.
Category:
Original articles
Summary
Introduction:
This study was undertaken to determine the feasibility of endoscopic vein harvest (EVH) for infrainguinal arterial bypass surgery. We describe our initial experience and early results of bypasses done using this minimally invasive approach.
Method:
From April 2012 to March 2015, 16 patients underwent 16 femoropopliteal bypass operations with great saphenous vein (GSV) being harvested by endoscopic technique. The indication for intervention was critical limb ischemia (Rutherford category “5”) in 7 patients (43.7%) and severe intermittent claudication (Rutherford category “3”) in 9 patients (56.3%). There were 14 male (87.5%) and 2 female (12.5%) patients, with a mean age of 59.9 years. Selection of patients for EVH was based on clinical and duplex ultrasound appearance of GSV. Only patients with adequate GSV were considered for EVH. We collected data regarding patients’ demographics, history, clinical findings, operative procedures and postoperative recovery including complications. Patients were followed at 3, 6, 12, 18 and 24 months postoperatively and yearly thereafter. Patencies were analyzed by Kaplan-Meier method. Statistical analysis was performed using IBM SPSS Statistics 21.0 software (IBM Corp, Armonk, NY).
Results:
Endoscopically harvested GSV was utilised for formation of proximal (10; 62.5%) or distal (6; 37.5%) femoropopliteal bypass. One patient underwent conversion to open harvest after endoscopic dissection of the vein. It occurred early in our experience. All other GSV harvests were accomplished endoscopically. 2 patients (12.5%) developed postoperative surgical site infection (SSI) Szilagyi gr. II (1 patient after successful EVH – location: groin; 1 patient after conversion of EVH to open vein harvest – location: groin and vein harvest incision). Mean follow-up was 10.2 months (range 0.3 to 27.0 months). At 1 and 2 years, primary patency was 82.0% and 82.0%, assisted primary patency was 93.8% and 93.8%, and secondary patency was 100.0% and 100.0%. At 1 and 2 years, amputation-free survival was 100.0% and 100.0%. No patient died within the study period (mortality 0.0%).
Conclusions:
Endoscopic harvest of GSV is a minimally invasive alternative to a standard open harvest of GSV. It is a feasible option for patients undergoing infrainguinal arterial bypass. In our early experience, patencies of EVH femoropopliteal bypasses are comparable to those achieved using traditional open vein harvest technique. Combination of endoscopic vein harvest with femoropopliteal bypass formation results in a low incidence of surgical site infections.
Key words:
endoscopic vein harvest – great saphenous vein – peripheral vascular surgery – femoropopliteal bypass – minimally invasive vascular surgery
Zdroje
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