Defining the learning curve of the endovascular in situ saphenous vein bypass: Operative data from 115 cases by recently trained surgeons

To record surgeons' results of endovascular in situ saphenous vein (EISV) b ypasses during the learning curve phase, randomly selected patients were ev aluated who were undergoing EISV bypass performed by surgeons who had been recently trained in the Side Branch Occlusion system. An independent observ er recorded the technical details at each operation on a standardized data sheet that included: number of coils deployed, misdeployed coils, additiona l incisions required to occlude side branches, irrigation volume, vein prep aration time, operative time, and technical complications. Operations were stratified into four subjective categories based on the technical aspects o f the operation: (1) good results; (2) good results, minor technical issues ; (3) good results, major technical issues; and (4) poor results. Sixty-fou r surgeons performed 115 EISV bypasses. Eighty-seven (76%) of the procedure s were classified as either good results or minor technical problems. Major technical problems occurred in 10 patients, and 18 patients (15%) had poor results. Neither site of the distal anastomosis nor the saphenous vein len gth affected the technical success of the procedure. The average volume of irrigation was 3,000 mt and mean vein preparation time was 84 minutes (rang e 15-300 minutes). Coils were misdeployed in 59 (51%) cases, and 49 patient s (42%) required additional incisions on the leg. EISV bypass offers signif icant theoretical advantages over open in situ vein bypass; however, it is challenging, and technical complications occurred in nearly 25% of cases du ring the learning phase. Aberrant venous anatomy poses the greatest challen ge to the success of the EISV, and the ability of the surgeon to recognize and respond appropriately to these anomalies often dictates the success of the procedure. Further studies will be necessary to evaluate the clinical b enefits of this new technique.