Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses

Research output: Contribution to journalArticle

Abstract

Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH)vs open vein harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH and that improved patency can be achieved with experience. Methods: This was a single-institution review of 113 patients with critical limb ischemia who underwent infrainguinal bypass with a continuous segment of great saphenous vein harvested endoscopically (n = 49)or through a single open incision (n = 64)from 2012 to 2017. EVH was performed by surgeons with >5 years' experience with this technique. Operative outcomes, patency, complications, and readmission rates were compared between the harvest methods. EVH data were also compared with our prior reported series of our initial experience with this technique to determine the effects of experience on outcomes. Results: There were no significant differences in patient demographics, medications, operative indications, or inflow/outflow vessels between the two groups. Mean operative time was 322 minutes and median hospital length of stay was 6 days for OVH, and was 340 minutes and 5 days for EVH, which was not significant. Harvest-related wound complications were more frequent with OVH (28% vs 2%, P <.001). Primary patency at 1 and 3 years was 65% and 58% for OVH, and 79% and 71% for EVH, respectively (P =.18), assisted primary patency was 77% and 74% for OVH and 94% and 89% for EVH, respectively (P =.05), and secondary patency was 82% and 79% for OVH and 95% and 95% for EVH, respectively (P =.03). The 30-day readmission rates were similar between OVH (20%)and EVH (12%, P =.26), but 90-day readmissions were more frequent in the OVH group (34% vs 14%, P =.018). Compared with our earlier series of EVH, the current cohort had significantly improved 3-year primary (71% vs 42%, P =.012), primary assisted patency (89 vs 66%, P =.034), and secondary patency (95% vs 66%, P =.003). Conclusions: With experience, lower extremity bypass using EVH can result in improved patency compared with OVH and initial EVH use, while also resulting in fewer wound complications and readmissions, with comparable operative times and hospital length of stay. This technique should be more widely adopted by vascular surgeons as a primary method of vein harvest.

Original languageEnglish (US)
JournalJournal of vascular surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Saphenous Vein
Lower Extremity
Veins
Wounds and Injuries
Length of Stay
Operative Time

Keywords

  • Chronic limb-threatening ischemia
  • Endoscopic vein harvest
  • Lower extremity bypass
  • Open vein harvest

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{01d3ac091cc2452ead63d9acbc661a6a,
title = "Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses",
abstract = "Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH)vs open vein harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH and that improved patency can be achieved with experience. Methods: This was a single-institution review of 113 patients with critical limb ischemia who underwent infrainguinal bypass with a continuous segment of great saphenous vein harvested endoscopically (n = 49)or through a single open incision (n = 64)from 2012 to 2017. EVH was performed by surgeons with >5 years' experience with this technique. Operative outcomes, patency, complications, and readmission rates were compared between the harvest methods. EVH data were also compared with our prior reported series of our initial experience with this technique to determine the effects of experience on outcomes. Results: There were no significant differences in patient demographics, medications, operative indications, or inflow/outflow vessels between the two groups. Mean operative time was 322 minutes and median hospital length of stay was 6 days for OVH, and was 340 minutes and 5 days for EVH, which was not significant. Harvest-related wound complications were more frequent with OVH (28{\%} vs 2{\%}, P <.001). Primary patency at 1 and 3 years was 65{\%} and 58{\%} for OVH, and 79{\%} and 71{\%} for EVH, respectively (P =.18), assisted primary patency was 77{\%} and 74{\%} for OVH and 94{\%} and 89{\%} for EVH, respectively (P =.05), and secondary patency was 82{\%} and 79{\%} for OVH and 95{\%} and 95{\%} for EVH, respectively (P =.03). The 30-day readmission rates were similar between OVH (20{\%})and EVH (12{\%}, P =.26), but 90-day readmissions were more frequent in the OVH group (34{\%} vs 14{\%}, P =.018). Compared with our earlier series of EVH, the current cohort had significantly improved 3-year primary (71{\%} vs 42{\%}, P =.012), primary assisted patency (89 vs 66{\%}, P =.034), and secondary patency (95{\%} vs 66{\%}, P =.003). Conclusions: With experience, lower extremity bypass using EVH can result in improved patency compared with OVH and initial EVH use, while also resulting in fewer wound complications and readmissions, with comparable operative times and hospital length of stay. This technique should be more widely adopted by vascular surgeons as a primary method of vein harvest.",
keywords = "Chronic limb-threatening ischemia, Endoscopic vein harvest, Lower extremity bypass, Open vein harvest",
author = "Matthew Kronick and Timothy Liem and Enjae Jung and Cherrie Abraham and Moneta, {Gregory (Greg)} and Gregory Landry",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2019.02.043",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses

AU - Kronick, Matthew

AU - Liem, Timothy

AU - Jung, Enjae

AU - Abraham, Cherrie

AU - Moneta, Gregory (Greg)

AU - Landry, Gregory

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH)vs open vein harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH and that improved patency can be achieved with experience. Methods: This was a single-institution review of 113 patients with critical limb ischemia who underwent infrainguinal bypass with a continuous segment of great saphenous vein harvested endoscopically (n = 49)or through a single open incision (n = 64)from 2012 to 2017. EVH was performed by surgeons with >5 years' experience with this technique. Operative outcomes, patency, complications, and readmission rates were compared between the harvest methods. EVH data were also compared with our prior reported series of our initial experience with this technique to determine the effects of experience on outcomes. Results: There were no significant differences in patient demographics, medications, operative indications, or inflow/outflow vessels between the two groups. Mean operative time was 322 minutes and median hospital length of stay was 6 days for OVH, and was 340 minutes and 5 days for EVH, which was not significant. Harvest-related wound complications were more frequent with OVH (28% vs 2%, P <.001). Primary patency at 1 and 3 years was 65% and 58% for OVH, and 79% and 71% for EVH, respectively (P =.18), assisted primary patency was 77% and 74% for OVH and 94% and 89% for EVH, respectively (P =.05), and secondary patency was 82% and 79% for OVH and 95% and 95% for EVH, respectively (P =.03). The 30-day readmission rates were similar between OVH (20%)and EVH (12%, P =.26), but 90-day readmissions were more frequent in the OVH group (34% vs 14%, P =.018). Compared with our earlier series of EVH, the current cohort had significantly improved 3-year primary (71% vs 42%, P =.012), primary assisted patency (89 vs 66%, P =.034), and secondary patency (95% vs 66%, P =.003). Conclusions: With experience, lower extremity bypass using EVH can result in improved patency compared with OVH and initial EVH use, while also resulting in fewer wound complications and readmissions, with comparable operative times and hospital length of stay. This technique should be more widely adopted by vascular surgeons as a primary method of vein harvest.

AB - Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH)vs open vein harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH and that improved patency can be achieved with experience. Methods: This was a single-institution review of 113 patients with critical limb ischemia who underwent infrainguinal bypass with a continuous segment of great saphenous vein harvested endoscopically (n = 49)or through a single open incision (n = 64)from 2012 to 2017. EVH was performed by surgeons with >5 years' experience with this technique. Operative outcomes, patency, complications, and readmission rates were compared between the harvest methods. EVH data were also compared with our prior reported series of our initial experience with this technique to determine the effects of experience on outcomes. Results: There were no significant differences in patient demographics, medications, operative indications, or inflow/outflow vessels between the two groups. Mean operative time was 322 minutes and median hospital length of stay was 6 days for OVH, and was 340 minutes and 5 days for EVH, which was not significant. Harvest-related wound complications were more frequent with OVH (28% vs 2%, P <.001). Primary patency at 1 and 3 years was 65% and 58% for OVH, and 79% and 71% for EVH, respectively (P =.18), assisted primary patency was 77% and 74% for OVH and 94% and 89% for EVH, respectively (P =.05), and secondary patency was 82% and 79% for OVH and 95% and 95% for EVH, respectively (P =.03). The 30-day readmission rates were similar between OVH (20%)and EVH (12%, P =.26), but 90-day readmissions were more frequent in the OVH group (34% vs 14%, P =.018). Compared with our earlier series of EVH, the current cohort had significantly improved 3-year primary (71% vs 42%, P =.012), primary assisted patency (89 vs 66%, P =.034), and secondary patency (95% vs 66%, P =.003). Conclusions: With experience, lower extremity bypass using EVH can result in improved patency compared with OVH and initial EVH use, while also resulting in fewer wound complications and readmissions, with comparable operative times and hospital length of stay. This technique should be more widely adopted by vascular surgeons as a primary method of vein harvest.

KW - Chronic limb-threatening ischemia

KW - Endoscopic vein harvest

KW - Lower extremity bypass

KW - Open vein harvest

UR - http://www.scopus.com/inward/record.url?scp=85066245368&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066245368&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2019.02.043

DO - 10.1016/j.jvs.2019.02.043

M3 - Article

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

ER -