Endovascular in Situ Bypass Decreases Morbidity and Hospital Stay following Infrainguinal Arterial Reconstruction

Abstract

EISVB provides early patency comparable to conventional in situ infrainguinal bypass. Its distinct advantages, however, are the ability to minimize incision length with resultant reductions in wound-related complications, hospital LOS, and recovery time. EISVB promises to be a useful adjunct in the approach to peripheral vascular insufficiency.

Initial experience with minimally invasive in situ bypass procedure with blind valvulotomy

“…For limitation of incisional complications associated with in situ grafting, angioscopy and duplex ultrasound scan have been used to advantage, with early and midterm reports that appear to show reduced wound morbidity rate and hospital length of stay (LOS) without compromise of patency. [14][15][16][17][18] Instrumentation has been designed in an effort to make direct visualization of valves and branches with relatively costly equipment unnecessary. Previous work has shown, however, that such "blind" valvulotomy may be associated with an 85% incidence rate of vein injury and an 18.9% incidence rate of residual competent valves.…”

Open Surgical versus Minimally Invasive in Situ Femorodistal Bypass: Long-term Results

“…Other investigators have published similar observations. [8][9][10] Although the closed operation itself costs more, the total expenditure for the closed procedure in our study was lower than the open technique due to reduced hospital costs ($6322 versus $8030). 4 More recently, Nelson et al 9 corroborated these findings in their study of 46 endovascular-assisted in situ sa-phenous vein bypass procedures versus a historical control group of conventionally treated patients.…”

“…In more than a third of the closed procedures, arteriovenous fistulas remain (42% versus 8% in the open procedure 4 ); ϳ6% are hemodynamically significant and require closure. 8 In conclusion, the closed technique for femorodistal in situ bypass yields equivalent long-term (4-year) patencies compared to the traditional open technique. This, in combination with the demonstrated lower cost of the closed procedure, makes it an attractive alternative to the open in situ femorodistal bypass procedure; however, it is a difficult procedure to perform, requiring a skilled interventionist.…”