ASSESSING OUTCOMES, COSTS, AND BENEFITS OF EMERGING TECHNOLOGY FOR MINIMALLY INVASIVE SAPHENOUS-VEIN IN-SITU DISTAL ARTERIAL BYPASSES

Background: Instrumentation for a minimally invasive angioscopic in si tu peripheral arterial bypass (MIAB) with catheter-directed side-branc h occlusion has recently been approved for use. Despite the attractive ness of this approach (2 short incisions), benefits such as lower morb idity and shorter hospitalizations remain undocumented. To justify wid e acceptance, minimally invasive surgical techniques must match conven tional procedures in durability and cost while enhancing patient comfo rt. Often such comparisons are difficult during the implementation pha se of a new procedure. Objective: To compare the outcomes of the MIAB procedures with a concurrent group of patients undergoing conventional in situ bypass procedures. Design: Retrospective review. Setting: Uni versity medical center. Patients: The first 20 consecutive MIAB proced ures in 19 patients performed between August 1, 1995, and July 31, 199 7, were compared with 19 contemporaneous consecutive conventional in s itu bypass procedures performed at the same institution. Main Outcome Measures: Operative time, postoperative length of stay, hospital costs , complications, primary assisted and secondary patency, limb salvage, and survival. Results: The patient groups were comparable with respec t to age, sex, incidence of smoking, coronary artery disease, hyperten sion, diabetes, renal failure, cerebrovascular disease, indication, an d distal anastomosis level. The median operative time was significantl y greater for the MIAB group (6.6 hours vs 5.7 hours; P=.009), and int raoperative completion arteriography more frequently showed retained a rteriovenous fistulas in the MIAB group (55% vs 21%, P=.05). The media n postoperative length of stay and total cost were 6.5 days and $18000 for the MIAB group and 8 days and $27800 for the conventional group ( P greater than or equal to.05). There were no significant differences in major complications (10% in the MIAB group vs 11% in the convention al group), wound complications (10% vs 11%, respectively), primary ass isted patency at 1 year (68%+/-11% vs 78%+/-10%, respectively), second ary patency at 1 year (79%+/-10% vs 88%+/-8%, respectively), limb salv age at I year (85%+/-10% vs 94%+/-6%, respectively), or patient surviv al at 1 year (89%+/-8% vs 61%+/-13%, respectively). Conclusion: Patien ts undergoing the MIAB procedure avoided lengthy vein exposure incisio ns without sacrificing short-term results. There was a trend toward de creased hospital stay and cost, which may be further realized as the c linical experience broadens. Although longer follow-up and larger coho rts will always be required to define durability, immediate access to outcomes and costs on small numbers of patients facilitates the early assessment of emerging technology.