Open versus endoscopic great saphenous vein harvest for lower extremity revascularization of critical limb ischemia

Abstract

OVH and EVH have similar failure mechanisms, limb salvage, amputation-free survival, and overall survival. EVH is associated with impaired patency, increased need for intervention, longer operative times, shorter hospital stays, and decreased vein harvest site wound complications. OVH of the great saphenous vein may provide optimal patency but was not necessarily associated with better patient-centered outcomes. Similar limb salvage rates and amputation-free survival may justify the use of EVH, despite inferior patency, to capture shorter hospital stays and decreased wound complications.

Endoscopic vein harvest does not negatively affect patency of great saphenous vein lower extremity bypass

“…Although our overall wound complication rate of 43% in the OVH group seems high, it includes all complications including Szilagyi I, and it is not too dissimilar from the previous reported rates in series from single academic centers (23%-44%). 10,11,15,19 Our study also found that both BMI and prior surgery were independently associated with wound complications. The relationship between increased BMI and surgical wound complications has been demonstrated in several previous studies.…”

“…One of the concerns is inferior patency and increased rates of reinterventions associated with EVH. [10][11][12][13][14]16 Our study shows that in experienced hands, EVH is associated with similar graft patency, reintervention rates, and limb salvage and fewer harvest site complications.…”

“…7 However, EVH has been used less frequently in lower extremity bypass surgery, with studies showing variable results in terms of wound complications. [8][9][10][11][12][13][14][15][16] Moreover, there is concern about inferior patency and increased reinterventions with EVH compared with OVH. [10][11][12][13][14]16 A recent meta-analysis of series between 1996 and 2013 on EVH revealed not only decreased patency rates in the EVH groups but also no advantage in wound complication rates.…”

“…14 However, two other series from high-volume academic centers found significant decrease in wound complications with decreased primary patency but comparable limb salvage rates. 10,11 We started using EVH in 2008 in collaboration with our cardiac surgery physician assistant with extensive experience in this technique mainly because of our dissatisfaction with harvest site wound complications and a few early in situ vein graft occlusions for unclear reasons. EVH became our preferred approach shortly after we started using this technique.…”

Neointimal hyperplasia in allogeneic and autologous venous grafts is not different in nature

“…Handling of the surgically harvested vein is a strong outcome determinant (Conte 2009;Santo et al 2013). Preimplantation histological analysis has been proposed (Giannoukas et al 1997).…”