Peripheral Vascular Surgery Society

Purpose: To evaluate complications and results of endoscopically assisted saphenous vein in situ bypass compared to reversed greater saphenous vein revascularization.

Methods: Between August 1996 and March 1998, 56 patients with adequate saphenous vein required a femoro-distal bypass. Minimally invasive in situ technique (MIIST) was done in 26 using the EthiconÒ vein harvest trayÔ , while 30 had a reversed saphenous vein bypass (RGSV). Age of patients, presence of diabetes mellitus, renal failure, and tobacco use were similar between patient groups, as was use of popliteal, tibial and infra-malleolar target vessels. All patients had severe claudication or limb-threat. Patients with adequate ipsilateral GSV underwent the MIIST. If only contralateral vein was available, RGSV bypass was done. Endpoints of intraoperative and postoperative wound complications, cellulitis, a-v fistula persistence and graft patency were compared. Analysis was done according to intention to treat and by operation accomplished.

Results: MIIST required 2 incisions in a majority of cases, but 5 of 26 had a technical problem necessitating an open in situ (3) or a composite non-reversed bypass (2). Three limbs in the RGSV group required a composite reconstruction. Three avulsed venous tributaries during MIIST required separate incisions for repair. Time for the MIIST decreased from 81 to 20 minutes between the first 5 cases and the last 5. Five RGSV patients and one MIIST patient had wound complications (p<0.05). Postoperative graft surveillance revealed one failed graft in each group. Postoperative ABIâs were 0.87 (MIIST) and 0.90 (RGSV), range 0.62 to 1.1 at a mean follow-up of 1 year.

Conclusions: Minimally invasive techniques suffice for ligation of venous tributaries for in situ femoral-distal bypasses. Intra-operative complications encountered early on and decreasing operative times demonstrate the learning curve, but potentially fewer wound complications without sacrifice of one year patency make the technique temptingly attractive. Increased experience and long term follow-up is needed to define the proceduresâ utility.