Endoscopically assisted in situ lower extremity bypass graft: A preliminary report of a new minimally invasive technique

Objective: Lower extremity arterial reconstructions with in situ greater sa phenous vein (GSV) are an important component of limb salvage surgery. Init ially, die procedure was performed through continuous skin incisions for si de branch occlusion and valve lysis with a wound complication rate of 5% to 25%. To decrease these complications, we used endoscopic GSV harvest equip ment in 25 in situ vein bypass grafts in 25 patients performed over 24 mont hs. Methods. The procedures were performed with three skin incisions: two for a rterial access and a 2-cm incision above the knee to insert the Endopath de vice (Ethicon) to locate and clip the GSV side branches. After completion o f the proximal anastomosis, the valves were lysed through the distal end of the vein with a flexible valvulotome. Completion cineangiography was perfo rmed to confirm side branch occlusion and evaluate the entire reconstructio n. The results of this technique were compared with our last 25 in situ byp ass grafts done with standard long incisions. Results. In the endoscopic group there was one (4%) minor wound complicatio n (cellulitis). No postoperative arteriovenous fistulas were detected by me ans of duplex examination, and the average hospital stay was 6.2 +/-1 days, One graft closed at 9 months as a result of distal vein hyperplasia, but t he other grafts have remained patent, with follow-up from 6 to 30 months (m ean, 18 months). Patients with the standard in situ bypass grafts had signi ficantly (P<.05) more wound complications (20%) and longer average hospital stay (9.2<plus/minus>2 days) than the endoscopic group. Patency rates were comparable for both groups. Conclusion: These results show that less invasive endoscopic in situ bypass grafting minimizes wound complications and reduces the need for hospitaliz ation without decreasing patency or increasing operative time.