A COMPARISON OF ENDOVASCULAR ASSISTED AND CONVENTIONAL IN-SITU BYPASSGRAFTS

Thirty-three in situ saphenous vein bypass grafts were performed using a conventional open technique (CI) while 31 in situ bypass grafts wer e performed using endovascular occlusion of side branches (EAI). Bypas s grafts were performed from the femoral to the popliteal (n = 37) or a trifurcation (n = 27) artery for claudication (n = 7), rest pain (n = 14), or tissue loss (n = 43). Wound complications developed in 11 CI and four EAI limbs. Postoperative hospitalization in CI and EAI patie nts was, respectively, 8.4 +/- 2.0 days and 4 +/- 1.6 days. Missed art eriovenous fistulas were noted in one CI and 17 EAI limbs postoperativ ely. At follow-up four (12%) CI and six (19%) EAI grafts were occluded or had undergone revision surgery. Based on life-table analysis CI an d EAI cumulative patency rates at 18 months were 79% and 83%, respecti vely. Although this new technique (EAI bypass grafting) did not reduce operative time, it did decrease the length of surgical incisions and the duration of postoperative hospitalization (p < 0.001, Student's t test). Wound complications occurred less frequently in EAI limbs but t he incidence of missed arteriovenous fistulas was significantly higher . These data suggest that EAI and CI patency is comparable. Ultimately long-term patency will be the crucial test for determining the utilit y of this new technique.