Long-Term Results of Endoscopic Versus Open Saphenous Vein Harvest for Lower Extremity Bypass

Background: Endoscopic saphenous vein harvest (EVH) has been shown to lower wound infection rates and cost compared with conventional harvest, although long-term patency data are lacking. A small series of studies has recently suggested that patency is inferior to conventionally harvested vein technique, and we thus sought to explore this question by reviewing our cumulative experience with this technique. Methods: The short-and long-term outcomes of all lower extremity bypasses (LEBPs) using saphenous vein at one institution over a period of 8.5 years were retrospectively reviewed. Results: A total of 363 patients averaging 67 +/- 24 to 100 years of age had undergone LEBP and had charts available for review. Of these 363 patients, 170 underwent EVH (90% using a noninsufflation technique) and 193 conventional (by means of continuous or skip incisions); 48% of patients reported tissue loss and no differences in indication for surgery were noted between groups. Mean follow-up was 35.1 (range: < 1-105) months. Primary patency rates were worse in the EVH group as compared with conventional at six (63.3% +/- 4.0% vs. 77.3% +/- 3.3%), 12 (50.4% +/- 4.2% vs. 73.7% +/- 3.6%), and 36 (42.2% +/- 4.5% vs. 59.1% +/- 4.9%) months (all p < 0.001), although these differences were largely limited to patients with limb-threat and diabetes. However, limb salvage and survival, were identical between groups. Contrary to previous experience, there were no differences in length of stay or wound complication rates. Conclusions: The overall results of this study show an inferior long-term patency rate for endoscopically harvested saphenous vein after LEBP in our series as a whole, and do not confirm the short-term benefit previously shown in a selected cohort. These differences were, however, minimal or absent in patients with claudication or absence of diabetes, and EVH may continue to play a role in these cases.