Endoscopic versus open great saphenous vein harvesting for lower extremity arterial bypass: A systematic review, meta-analysis and meta-regression.

Abstract

Objective: To compare postoperative outcomes of patients undergoing lower extremity arterial bypass (LEAB) for peripheral artery disease (PAD) with endoscopic great saphenous vein harvest (EVH) versus open vein harvest (OVH), and to investigate the impact of publication year on bypass patency.

Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception through January 2025 for comparative studies of EVH versus OVH in LEAB. Individual patient data were reconstructed from Kaplan-Meier curves and analysed using Cox proportional hazards models. Binary and continuous outcomes were pooled using random-effects models. Meta-regression and subgroup analyses by publication year (≤2015 vs >2015) were performed to explore temporal trends in patency.

Results: Thirteen retrospective cohort studies comprising 12 401 patients were included. EVH was associated with higher risk of primary patency loss compared with OVH (HR 1.32; 95% CI 1.04-1.68; p=.030) and a borderline longer operative time (MD 58.98 minutes; 95% CI 0.63-117.32; p=.050; I²=96%), but significantly lower wound complications (RR 0.68; 95% CI 0.57-0.80; p<.001). No differences were observed in primary-assisted patency, secondary patency, length of stay, major amputation, limb salvage, or mortality. Subgroup analysis showed that the primary patency disadvantage was driven by studies published up to 2015 (HR 1.49; p=.010), with no significant difference in studies published after 2015 (HR 0.97; p=.900), although the interaction test was not significant (p=.100). Meta-regression did not demonstrate an association between publication year and primary patency effect size (p=.890).

Conclusion: EVH significantly reduces wound complications but is associated with lower primary patency and potentially longer operative times compared with OVH, disadvantages that do not translate into differences in secondary patency, limb salvage, major amputation, or mortality. Further prospective studies are needed to define the role of EVH to better inform LEAB operative planning.