Peripheral Vascular Surgery Society

John D. Martin, MD

Horizon Surgical Group, Potomac, MD

The endovascular in-situ saphenous vein bypass (EISV) is a new minimally invasive method for lower extremity revascularization using angioscopic-guided deployment of Gianturco coils into the venous tributaries and valvulotomy. There is no reference data to know what to expect with this new technique, therefore we undertook a study of the preliminary cases of surgeons nationwide to determine the typical fluid requirements, number of coils required, time for vein preparation, number of extra incisions and likelihood for success. The data was collected at the time of the procedure by an observer who was not a member of the operating team.

Sixty-four surgeons received training through a one-day course and performed 115 bypasses over 5 months.

Femoral-popliteal (BK) 50 4.8 2973

Femoral-posterior tibial 27 5.0 2802

Femoral-anterior tibial 20 5.1 3410

Femoral-peroneal 8 7.1 3549

Femoral-dorsalis pedis 9 9.2 3905

Popliteal-tibial 1 5.0 3300

Under 2000 cc of irrigation was used in 30% of cases and over 50% required between 2 and 4 liters. The average vein preparation time was 84 minutes (range 15-300) but the majority required between 30 minutes to 1 hour. Eighty-seven (76%) of the procedures were classified as either good-results, no technical issues or good-results, minor technical problems. Major technical problems occurred in 10 patients and 18 patients (15%) had poor results. The outflow vessel and length of the saphenous vein treated did not affect the technical success of the procedure. Coils were mis-deployed in 59 cases and 49 patients (41%) required additional incisions on the leg. Vein perforation occurred in three cases and was the result of difficult venous anatomy.

EISV bypass offers significant theoretical advantages over standard bypass techniques. However, it is technically challenging, and technical complications occur in almost 25% of cases during the learning phase. Variations in venous anatomy pose the greatest challenge to the surgeon and oneâs ability to recognize and respond appropriately to these anomalies often dictates the success of the procedure. Further studies will be necessary to quantify the clinical benefits offered by this new technique.