Vein Harvest Technique Is Not Associated with Major Adverse Limb Events.

Abstract

Background: Benefits of vein conduits in lower extremity bypasses (LEB) are known but there is debate about the harvesting technique. We aimed to compare the impact of conduit harvest on major adverse limb event (MALE) and MALE-free survival (MFS).

Methods: We conducted a retrospective review of LEB patients with vein from 2013-2022 at our single-center institution. Patients were divided into groups: EVH (n=80) and OVH (n=204). The primary endpoints were MALE and MFS, while secondary endpoints included 30-day infection rate (IR), operative time, discharge status, post-operative length-of-stay (LOS), and estimated blood loss (EBL). MALE and MFS were compared using log ranks and Kaplan-Meier analysis. Adjusted analyses to determine factors associated with MALE and MFS at 1-, and 3-years were performed.

Results: At 1- and 3-years, MALE and MFS were not statistically different. At 1-year, EVH MALE was 35% vs. 37% for OVH (p=0.871), and 61% vs. 55% (p=0.434) at 3-years. At 1-year, EVH MFS was 63% vs. 65% for OVH (p=0.434), and 39% vs. 45% (p=0.44) at 3-years. There were no significant differences in 30-day IR (1.25% vs. 3.88%; p=0.30), EBL (397.31 ± 336.00 vs. 479.57 ± 493.81 mL; p=0.12), discharge home vs. other facility (88.61% vs. 85.92%; p=0.63), and LOS (7.09 ± 4.98 vs. 7.92 ± 6.24 days; p=0.30). On adjusted analyses, harvest technique was not associated with MALE or MFS at 1- and 3-years. Adjusted analyses revealed no association between vein harvest technique and MALE at 1-year. It did show significant differences in MALE at 1-year for bypasses whose proximal anastomoses originated in the below-knee popliteal and tibial artery segments (HR, 2.50; 95% CI, 1.30-4.80; p=0.01) and bypasses that consisted of 2 or more vein segments (HR, 1.86; 95% CI, 1.25-2.76; p<0.01); both findings were still significant at 3-years and neither were associated with vein harvest technique. There were no co-morbidities that affected MALE at 1-year, but patients with MALE at 3-years were associated with COPD (HR, 1.46; 95% CI, 1.08-1.99; p=0.02) and diabetes (HR, 1.51; 95% CI, 1.12-2.03; p=0.01). There were no variables associated with a return to the operating room except for female sex (OR, 2.317; 95% CI, 1.214-4.424; p=0.011). There was still no difference in 30-day IR even after adjusted analysis.

Conclusion: Although EVH is not associated with improved infection rates and LOS, this technique does not affect MALE or MFS compared to OVH. Economic impact and patient satisfaction of EVH require further studies to define the role of less invasive approaches to vein harvest.