ENDOSCOPIC FEMORAL-POPLITEAL DISTAL BYPASS-GRAFTING - A PRELIMINARY-REPORT/

Background: Patients requiring limb bypass or coronary artery bypass p rocedures frequently develop vein harvest-associated complications. Mi nimally invasive surgical techniques that can be employed during disse ction of the greater saphenous vein could potentially reduce the signi ficant incisional morbidity concomitant with this procedure. Study Des ign: An endoscopic saphenous vein balloon dissector was developed and previously tested in the animal model. It was applied to a series of 1 6 leg bypass patients to dissect totally endoscopically the greater sa phenous vein for either translocated or in situ procedures. The clinic al course of these 16 patients was compared with the most recent 16 co nsecutive standard open saphenous vein bypass patients of similar age, disease, and risk factors. Results: No venous conduit injuries occurr ed with the endoscopic dissection technique, and only one minor wound seroma resulted in the harvest tunnel, requiring simple aspiration. Th e length of stay averaged 3.8 days, but the trend was downward to 1.8 days for the last 8 consecutive endoscopically dissected patients. In comparison, there were five major wound complications in the 16 open s aphenous vein bypass patients with an average length of stay of 6.2 da ys. Conclusions: Total endoscopic saphenous vein dissection for either translocated or in situ leg bypass patients can be performed atraumat ically for both the patient and the venous conduit. Wound/incisional c omplications are decreased, and length of stay appears to be reduced. Minimally invasive, endoscopic saphenous vein harvest may be beneficia l for both leg bypass patients and coronary artery bypass patients. (C ) 1998 by the American College of Surgeons.