Endovascular in situ bypass decreases morbidity and hospital stay following infrainguinal arterial reconstruction

Purpose: To report the early results of endovascular in situ saphenous vein bypass (EISVB) using side branch coil occlusion. Methods: Between September 1997 and November 1998, 25 patients (15 men; mea n age 70.9 years, range 53-85) with lower limb ischemia were treated with e ndovascular femorodistal bypass. The saphenous vein was prepared using retr ograde valvulotomy and endoscopic cannulation with coil occlusion of the si de branches. Duplex graft surveillance was performed at 1, 3, 6, and 12 mon ths. Results: The 25 EISVB procedures consisted of 15 femorodistal popliteal, 7 femorotibial, 2 femoroperoneal, and 1 femorodorsalis pedis in situ saphenou s vein reconstructions. Mean operative time was 202 +/- 40 minutes, mean nu mber of side branch coils per case was 5.1 +/- 1.3, and mean number of inci sions per case was 2.9 +/- 0.6. Mean hospital length of stay (LOS) was 35 /- 13 hours (1.4 +/- 0.6 days); 19 (76%) patients were discharged on the fi rst postoperative day. Short-term follow-up (mean 6.2 months, range 2-15) was notable for 2 graft thromboses and 1 graft stenosis; primary and secondary patency rates were 8 8% and 92%, respectively. Three asymptomatic, persistent arteriovenous fist ulas discovered on routine duplex were ligated in the outpatient setting. O nly 1 (4%) minor wound complication was encountered. Conclusions: EISVB provides early patency comparable to conventional in sit u infrainguinal bypass. Its distinct advantages, however, are the ability t o minimize incision length with resultant reductions in wound-related compl ications, hospital LOS, and recovery time. EISVB promises to be a useful ad junct in the approach to peripheral vascular insufficiency.