Endoscopic Vein Harvest and its Effect on Lower Extremity Arterial Bypass Patency.

Objective: The use of endoscopic vein harvest (EVH) versus open vein harvest (OVH) for lower extremity arterial bypass has been an area of continued interest. Previous studies have suggested wound complication rates are improved with EVH, but there has been concern for decreased patency of these grafts long term from possible damage with EVH techniques. This study aims to evaluate the effect of EVH and patency rates.

Methods: This retrospective study evaluated 340 patients who underwent any infrainguinal bypass with continuous segment GSV from 2013-2023 with OVH (n= 111) vs EVH (n= 229). Demographics, harvest technique, incisional breakdown and need for arterial procedure from 1-5 years were evaluated. Primary, primary assisted and secondary patency rates were evaluated.

Results: The average age was 62.6 ± 8.8 years and the majority of individuals were male (71.5%). The majority of participants were white (88.8%), current smokers (52.2%), had hypertension (78.0%), and an average BMI was 27.9 ± 6.0. Of these, 254 (75%) had below knee (BK) outflow targets and 86 (25%) with above knee (AK). Mean operative time was 193 minutes for EVH and was 228 minutes for OVH (p=0.03). Hospital length of stay was similar between the groups. Primary patency rates including above and below knee targets were 43.8% EVH vs 49.6% OVH [p=0.43], primary-assisted patency of 89.0% EVH vs 91.0% OVH [p=0.52], and secondary patency of 81% EVH vs 75.0% EVH [p=0.35]. Patients with EVH were less likely to have incision breakdown compared to OVH (11.9% vs 21.1%, p=0.04). A logistic regression model showed that EVH had a lower odd of failure of initial bypass requiring new bypass creation compared to OVH (adjusted OR: 0.66; 95% CI 0.33-0.99). Additionally, there was also a reduction in the odds of wound complications and need for amputation with EVH vs OVH.

Conclusions: This study found no significant difference in primary, primary-assisted and secondary patency rates when comparing EVH to OVH. The benefits of decreased operative time, similar patency rates and decreased wound complications is promising. When EVH is performed by experienced providers this technique could be considered for vein harvest, but future studies are needed to better evaluate its long-term efficacy.