| Abstract | 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 endoscopic vein harvest was performed in 214 limbs in 197 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 mellitus in 68% and dialysis-dependent renal failure in 11.7%. RESULTS: The procedure was successful in all but one patient. This patient was early in the series and had a friable varicose vein. Ipsilateral greater saphenous vein was used 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 to 48 months) is 77.2% by life-table analysis. For patients with claudication, rest pain, or minimal gangrene, the average length of stay was 3.15 days (range, 1 to 6 days). Wound complications occurred in 16 patients (7.5%), 10 of these required only local care (class I and II), and 6 had deep wounds threatening the leg or graft (class III). Only 5 patients, all with class III wounds, required readmission to the hospital for graft-related problems. 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, with short length-of-hospital stay, few wound complications, and low hospital readmission rates. Endoscopic vein harvest is recommended as the procedure of choice for vein procurement for infrainguinal bypass procedures. |
| Authors | Luke S Erdoes, Timothy P Milner
(Affiliation: University of Tennessee College of Medicine, USA. luke.erdoes at erlanger.org)
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| Journal | Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
(J Vasc Surg)
Vol. 42
Issue 3
Pg. 442-8
(Sep 2005)
ISSN: 0741-5214 United States |
| PMID | 16171585
(Publication Type: Journal Article)
|
| Topics |
- Adult
- Aged
- Aged, 80 and over
- Endoscopy
- Female
- Humans
- Inguinal Canal
(blood supply, surgery)
- Leg
(blood supply, surgery)
- Male
- Middle Aged
- Peripheral Vascular Diseases
(surgery)
- Postoperative Complications
- Risk Factors
- Saphenous Vein
(transplantation)
- Tissue and Organ Harvesting
(methods)
- Treatment Outcome
- Vascular Surgical Procedures
(methods)
|
