The durability of endoscopic saphenous vein grafts: A 5-year observationalstudy

Background: Endoscopic saphenous vein harvest has been explored as a minima lly invasive alternative to a long continuous leg incision for removal of t he greater saphenous vein. The endoscopic technique uses limited incisions (2-4) with extended "skin bridges" and videoscopic equipment for the dissec tion and removal of the greater saphenous vein. This study was undertaken t o evaluate the long-term durability of saphenous vein grafts harvested by a n endoscopic technique and used for lower extremity arterial revascularizat ion. Methods: All patients who underwent endoscopic saphenous vein harvesting fo r lower extremity arterial bypass grafting were prospectively followed for graft patency and risk factors. Grafts were surveyed with serial duplex sca ns at 3- to 6-month intervals over this 5-year study. Life-table methods we re used to assess graft survival. A computerized registry and medical recor ds were reviewed to determine graft patency and patient survival. Results: From September 1994 to August 2000, 164 lower extremity arterial s aphenous vein grafts harvested by an endoscopic technique were used for low er extremity arterial bypass grafting in 150 patients. The patient populati on included 111 males (75%) and 112 smokers (75%), but also included a high -risk cohort of 65 diabetic patients (43%) and 15 patients undergoing dialy sis/renal transplant (10%). Twenty-eight patients (19%) died within the stu dy period. With life-table methods, 1-, 3-, and 5-year secondary patency ra tes were 85% (+/- 3.2%), 74% (+/- 5.7%), and 68% (+/- 11.6%). Of the 30 fai led grafts, 7 (4%) failed in the first month related to inadequate runoff ( 4), cardiac instability (2), and an additional surgical procedure (1). Twen ty-three grafts (14%) failed between 1 and 42 months. Twenty-two (16%) of t hese 134 patent grafts underwent a second procedure to maintain patency (13 as primary-assisted patency and 9 as secondary patency). Conclusions. Endoscopic saphenous vein harvest for lower extremity arterial reconstruction provides a satisfactory conduit for lower extremity bypass grafting. Although increased manipulation from this limited access techniqu e may incite an injury response in the vein, these vein grafts can maintain an adequate patency for lower extremity bypass grafting.