Endoscopic Vein Harvest of Great Saphenous Vein Is Associated With Worse Long-term Outcomes in Infra-inguinal Bypass Patients

Document Type

Conference Proceeding

Publication Date

9-1-2024

Publication Title

J Vasc Surg

Abstract

Objectives: The effect of great saphenous vein (GSV) harvest technique on infra-inguinal bypass (IIB) outcomes remains a matter of debate, with no robust evidence favoring a specific technique. This study aims to compare the outcomes of open and endoscopic vein harvesting. Methods: Patients receiving IIB from a femoral origin using a single segment GSV between 2011 and 2023 were identified in the Vascular Quality Initiative (VQI). Patients receiving an in-situ bypass were excluded. Patients who underwent endoscopic vein harvest were one-to-three propensity score-matched with those receiving open vein harvest. Kaplan-Meier and Cox regression analysis were used to evaluate the long-term outcomes of patency, amputation, reoperation, and major adverse limb events (MALE). Results: A total of 2639 patients who underwent endoscopic vein harvest were matched to 7922 patients who underwent open vein harvest. The two groups were similar in all baseline and operative characteristics. Endoscopic harvesting of the GSV was associated with a lower rate of perioperative surgical site infection (SSI) compared with open harvesting (1.8% vs 2.9%; P < .001). Other perioperative outcomes were comparable between the two groups (Table). At 12-month follow up, the open harvesting group had higher primary patency (71% vs 65%; P < .001), higher secondary patency (90% vs 85%; P < .001), and lower MALE rates (25% vs 30%; P < .001) compared with the endoscopic harvesting group (Fig). Endoscopic harvesting was associated with increased risk of reoperation (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.10-1.36; P < .001), amputation (HR, 1.44; 95% CI, 1.20-1.73; P < .001), MALE (HR, 1.25; 95% CI, 1.13-1.37; P < .001), and loss of primary patency (HR, 1.30; 95% CI, 1.19-1.43; P < .001). Conclusion: The lower postoperative wound complication rate seen with endoscopic vein harvest comes at the expense of worse long-term patency outcomes. Open harvesting of GSV confers superior long-term outcomes of patency, reoperation, limb salvage, and MALE compared with endoscopic harvesting. [Formula presented] [Formula presented]

Volume

80

Issue

3

First Page

e56

Find It @ Sladen

Share

COinS