Endovascular-assisted versus conventional in situ saphenous vein bypass grafting: Cumulative patency, limb salvage, and cost results in a 39-month multicenter study

Abstract

The CISB and EISB midterm primary and secondary patency and limb salvage rates were statistically similar. In smaller veins (< 2.5 to 3.0 mm in diameter), however, EISB is not appropriate because overly aggressive instrumentation may cause intimal trauma, with resultant early graft failure. With the avoidance of a long leg incision in the EISB group, wound complications and hospital length of stay were significantly reduced, which lowered hospital charges and justified the additional cost of the endovascular instruments. When in situ bypass grafting is contemplated, EISB in appropriate patients is a safe, minimally invasive, and cost-effective alternative to CISB.

Use of Hand Held Doppler to identify venous tributaries in in situ vein arterial bypass

“…The disadvantages of these methods include availability of the necessary resource, expertise and equipment cost. Methods of occluding tributaries using angioscopy or endoscopic dissection have similar disadvantages and have not yet gained widespread popularity 7,15 …”

“…As originally described, each method requires significant exposure of the vein either for harvest (reversed) or to ligate venous tributaries (in situ). This long wound or series of wounds is associated with significant pain, infection and immobility 4–7 . More recently, the saphenous vein has been shown to be harvested endoscopically with encouraging results associated with low morbidity and short durations after completion of a learning curve 8,9 …”

“…This long wound or series of wounds is associated with significant pain, infection and immobility. [4][5][6][7] More recently, the saphenous vein has been shown to be harvested endoscopically with encouraging results associated with low morbidity and short durations after completion of a learning curve. 8,9 The locating and accurate marking of tributaries can achieve a reduction in the incision length, to reduce such morbidity in in situ grafting.…”

Preliminary Report of a New Approach to Sparing the Greater Saphenous Vein for Grafting: Valvuloplasty Combined with Axial Transposition of a Competent Tributary Vein

“…[32][33] The in situ technique for preparation of saphenous vein grafts has been regarded as the best method for femorodistal arterial reconstruction, [34][35][36][37] and newer minimally invasive endovascular-assisted techniques avoid lengthy incisions and decrease hospital stay and cost. 38 Several investigators have mentioned the need to save the saphenous vein for later coronary operations in patients undergoing peripheral outflow reconstruction. [39][40][41] Despite increased use of internal mammary artery (IMA) grafts, the GSV remains a common conduit for coronary artery grafting in most institutions; it is easy to use, and the difference in 5-year patency versus IMA grafts is not significant.…”

Extremitätenerhalt durch pedalen In-situ-Bypass beim diabetischen Fußsyndrom

“…Vielmehr erschien den Autoren die individuelle Venenbeschaffenheit für die Wahl der Methode entscheidend [11]. Plecha dagegen wies auf deutlich bessere Ergebnisse [15,20]. Seit Einführung der pedalen Bypasschirurgie wurde unabhängig von der Art der implantierten Vene eine hohe Rate von Wundheilungstörungen von bis zu 40 % mit der Gefahr einer Anastomosenbeteiligung beschrieben [4].…”