A NEW CLOSED IN-SITU VEIN BYPASS TECHNIQUE RESULTS IN A REDUCED WOUNDCOMPLICATION RATE

Objectives: This prospective randomised multicentre trial was conducte d to test whether a new ''closed'' technique for in situ vein bypass w ould result in a lower frequency of wound complications, without negat ive effects on patency rates and without an intolerable increase in re sidual arteriovenous fistulae compared to the conventional ''open'' te chnique. Methods: We have developed a new ''closed'' technique using a co-axial catheter embolisation system for intra-operative coil emboli sation of side branches, in order to avoid long incisions. Patients: I n four centres and 95 patients, 97 in situ bypasses were performed: 47 ''closed'' and 50 ''open''. Randomisation was stratified for below kn ee femoropopliteal bypasses (60) and femorocruml bypasses (37). Indica tions were disabling intermittent claudication (29), restpain (26) or ulcers and/or necrosis (42). Results: Postoperative mortality was 2% ( one in the ''closed'', one in the ''open'' group). A total number of 1 6 (34%) wound complications (grade 1, 2 and 3) occurred in the closed group compared to 36 (72%) in the open group (p < 0.05). Deep wound co mplications (grade 2) occurred in sir patients (13%) of the ''closed'' group, compared to 15 (30%) in the ''open'' group. In both groups, th ree patients (6%) developed deep wound complications including the byp ass area (grade 3). In the ''closed'' group, 20 patients needed additi onal treatment for arteriovenous fistulae, compared to four in the ''o pen'' group. One-year patency rates did not show a statistically signi ficant difference: primary patency rates were 65% and 61% and secondar y patency rates were 86% and 76% respectively for the ''closed'' and ' 'open'' group. Conclusion: These results indicate that a ''closed'' te chnique reduces wound complication rate, without negative effects on t he short term patency rates. The ''closed '' technique results in an i ncreased number of postoperative treatments for residual arteriovenous fistulae.