Ten-year experience of infrainguinal bypass with endoscopic vein harvest

Rhami Khorfan; Aela Vely; Farwa Batool; Miles W Jackson; M LaWaun Hance; Diane J Jones; Jarred A Napier; Michael J Heidenreich; Abdulhameed Aziz

doi:10.1177/17085381221142213

Ten-year experience of infrainguinal bypass with endoscopic vein harvest

Vascular. 2022 Nov 29:17085381221142213. doi: 10.1177/17085381221142213. Online ahead of print.

Authors

Rhami Khorfan¹, Aela Vely¹, Farwa Batool¹, Miles W Jackson¹, M LaWaun Hance², Diane J Jones², Jarred A Napier¹, Michael J Heidenreich³, Abdulhameed Aziz³

Affiliations

¹ Department of Surgery, 1261Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA.
² Section of Cardiac and Thoracic Surgery, Department of Surgery, Trinity Health Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA.
³ Section of Vascular Surgery, Department of Surgery, Trinity Health Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA.

PMID: 36446034
DOI: 10.1177/17085381221142213

Abstract

Objectives: There is conflicting data comparing minimally invasive vein harvest (MIVH) using endoscopic technique and open vein harvest (OVH) in terms of bypass patency, wound infection incidence, and patient morbidity. Our institution has performed MIVH since 2003 for peripheral bypass procedures with a consistent team of specialized endoscopic vein harvesters. This study reviewed the major outcomes of MIVH infrainguinal bypass at our institution given a predominant cohort of critical limb ischemia.

Methods: We performed a 10-year, retrospective, single-institution review from January 2005 to December 2014, identifying all patients undergoing MIVH for obstructive infrainguinal disease. Primary outcomes were primary patency, operative time, intraoperative complications, surgical site infection (SSI), and freedom from amputation.

Results: A total of 289 patients (70% male) underwent MIVH infrainguinal bypass at an average age of 68 ± 12 years old, an obesity prevalence of 28%, and with critical limb ischemia in 81% of the patient cohort (20% rest pain, 61% tissue loss/gangrene). Ninety-four percent of patients had no intraoperative complications, 2.5% had adverse cardiac or technical complications, and 4.2% of patients required transfusion. Average operative time was 4.2 h. Femoral-popliteal TASC classification C and D constituted 80% of our patient cohort. At the last follow-up, toe pressures had increased from 30 ± 30 to 62 ± 40 mmHg (p < 0.0001). Primary bypass patency in the first 30 days was 95%. SSI incidence requiring surgical treatment was only 6%. Our median length of stay was 4.0 days, with median intravenous narcotic use of 1 day. In addition, 77% of patients returned to their baseline mobility at first follow-up (median 19 days), and 83% of patients had freedom from amputation at last follow-up (median 820 days).

Conclusions: In a center with experience in MIVH and a consistent group of experienced endoscopic vein harvesters, MIVH bypass has excellent patency, low surgical site infection, short length of stay, and prompt return to baseline mobility.

Keywords: Minimally invasive; endoscopic vein harvest; leg bypass; lower extremity bypass.