Endoscopic Femoral-Popliteal/Distal Bypass Grafting: A Preliminary Report

• Published in: Journal of the American College of Surgeons Vol. 186; no. 3; pp. 331 - 336
• Main Authors: Johnson, Paul R, Tan, Swee Lian, Chin, Albert K
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1998; Elsevier Science; American College of Surgeons
• Subjects: Aged; Biological and medical sciences; Case-Control Studies; Coronary Artery Bypass - methods; Dissection - instrumentation; Endoscopy - methods; Female; Femoral Artery - surgery; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Popliteal Artery - surgery; Saphenous Vein - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Human; Endoscopic surgery; Femoral artery; Coronary artery; Samplings; Popliteal artery; Treatment; Bypass; Saphenous vein; Surgery; Graft; Technique; Dissection
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/S1072-7515(98)00014-3

Background: Patients requiring limb bypass or coronary artery bypass procedures frequently develop vein harvest-associated complications. Minimally invasive surgical techniques that can be employed during dissection of the greater saphenous vein could potentially reduce the significant incisional morbidity concomitant with this procedure. Study Design: An endoscopic saphenous vein balloon dissector was developed and previously tested in the animal model. It was applied to a series of 16 leg bypass patients to dissect totally endoscopically the greater saphenous vein for either translocated or in situ procedures. The clinical course of these 16 patients was compared with the most recent 16 consecutive standard open saphenous vein bypass patients of similar age, disease, and risk factors. Results: No venous conduit injuries occurred with the endoscopic dissection technique, and only one minor wound seroma resulted in the harvest tunnel, requiring simple aspiration. The length of stay averaged 3.8 days, but the trend was downward to 1.8 days for the last 8 consecutive endoscopically dissected patients. In comparison, there were five major wound complications in the 16 open saphenous vein bypass patients with an average length of stay of 6.2 days. Conclusions: Total endoscopic saphenous vein dissection for either translocated or in situ leg bypass patients can be performed atraumatically for both the patient and the venous conduit. Wound/incisional complications are decreased, and length of stay appears to be reduced. Minimally invasive, endoscopic saphenous vein harvest may be beneficial for both leg bypass patients and coronary artery bypass patients.