Gazoni Leo M, Carty Rebecca, Skinner John, Cherry Kenneth J, Harthun Nancy L, Kron Irving L, Tribble Curtis G, Kern John A
Department of Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
J Vasc Surg. 2006 Aug;44(2):282-7; discussion 287-8. doi: 10.1016/j.jvs.2006.03.047.
Although the use of endoscopic vein harvest (EVH) in coronary artery bypass grafting is accepted, few studies have documented the implementation of EVH in peripheral vascular disease surgery. We hypothesized that EVH improves outcomes compared with open vein harvest (OVH) in patients undergoing femoral to below the knee arterial bypass surgery.
The charts of 144 consecutive patients undergoing infrainguinal bypass surgery over the course of 27 months were reviewed. A femoral to below the knee arterial bypass with saphenous vein was done in 88 patients (29 had EVH, 59 had OVH). The preoperative characteristics evaluated were age, gender, renal function, history of diabetes, hypertension, tobacco use, and previous infrainguinal bypass surgery on the affected side. End points included wound complications, length of hospital stay, operative time, angiographic and operative interventions for graft occlusion, patency rates, limb salvage, acute renal failure, myocardial infarction, and death.
Patient characteristics and demographics were similar in the EVH and OVH groups. No operative intervention for occlusion was required in the EVH group (0/29) compared with 13.4% in the OVH group (8/59) (P = .03). At the mean follow-up time of 21 months, primary patency rate was 92.8% in the EVH group and 80.6% in the OVH group (P = .12). No significant differences were found between the EVH and OVH groups in postoperative complications, length of hospital stay, operative time, patency rates, limb salvage, and death.
Despite our initial concerns of damaging the venous conduit with a minimally invasive approach to saphenous vein harvest, EVH in our experience has resulted in a trend toward improved patency rates and decreased infectious wound complications while affording the benefit of improved cosmesis. An endoscopic approach results in smaller incisions, decreased interventions for occlusion, and improved outcomes compared with OVH. EVH is the procedure of choice for harvesting saphenous vein for femoral to below the knee arterial bypass surgery.
尽管冠状动脉搭桥术中使用内镜下静脉采集（EVH）已被认可，但很少有研究记录其在周围血管疾病手术中的应用情况。我们假设，在接受股动脉至膝下动脉搭桥手术的患者中，与开放静脉采集（OVH）相比，EVH能改善手术效果。
回顾了27个月内连续接受144例腹股沟下搭桥手术患者的病历。88例患者进行了股动脉至膝下动脉的大隐静脉搭桥手术（29例采用EVH，59例采用OVH）。评估的术前特征包括年龄、性别、肾功能、糖尿病史、高血压、吸烟情况以及患侧既往腹股沟下搭桥手术史。终点指标包括伤口并发症、住院时间、手术时间、移植物闭塞的血管造影和手术干预、通畅率、肢体挽救情况、急性肾衰竭、心肌梗死和死亡。
EVH组和OVH组患者的特征和人口统计学数据相似。EVH组无需进行闭塞的手术干预（0/29），而OVH组为13.4%（8/59）（P = 0.03）。在平均21个月的随访时间里，EVH组的一期通畅率为92.8%，OVH组为80.6%（P = 0.12）。EVH组和OVH组在术后并发症、住院时间、手术时间、通畅率、肢体挽救情况和死亡方面未发现显著差异。
尽管我们最初担心采用微创方法采集大隐静脉会损伤静脉管道，但根据我们的经验，EVH有提高通畅率和减少感染性伤口并发症的趋势，同时具有改善美观的优点。与OVH相比，内镜方法切口更小，闭塞干预减少，手术效果更好。EVH是股动脉至膝下动脉搭桥手术采集大隐静脉的首选方法。
