Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center, University of Southern California, Los Angeles, Calif, USA.
J Vasc Surg. 2013 Jun;57(6):1489-94. doi: 10.1016/j.jvs.2012.12.029. Epub 2013 Mar 13.
Endoscopic harvest of saphenous vein for infrainguinal arterial bypass decreases incision length and was initially documented to decrease wound complications without adversely affecting patency. However, recent studies have shown lower patency without a wound complication benefit. We sought to further define the wound complication and patency rates of endoscopic harvest compared with open harvest in infrainguinal arterial bypass procedures.
Infrainguinal bypasses performed from 2000 to 2011 were analyzed. Only procedures using a single segment of great saphenous vein were included. Cases were grouped according to endoscopic or open harvest and were frequency-matched for body mass index and diabetes. Baseline characteristics were compared. Univariate and multivariate analysis was performed to determine correlation of baseline data and harvest method on wound complications and patency.
The study included 76 bypasses; 35 in the endoscopic harvest group and 41 in the open harvest group. Baseline characteristics between the endoscopic and open harvest groups were not significantly different, with the exception of mean age, which was older in the endoscopic harvest group, and carotid artery disease, which was more common in the open harvest group. There was no significant difference between endoscopic and open harvest in 30-day wound complication rates (29% vs 27%; P = .87) or in the other perioperative variables, aside from decreased narcotic use in the endoscopic harvest group (P = .01). Mean follow-up was 747 days. There was no significant difference in 3-year primary (47% vs 49%; P = .8), 3-year primary-assisted (88% vs 73%; P = .1), or secondary patency rates (92% vs 76%; P = .09) at 3 years between the endoscopic and open harvest groups. High body mass index improved primary patency in the endoscopic harvest group (P = .02), but had no effect on patency in the open harvest group (P = .15). Patients requiring hemodialysis had increased risk for loss of primary assisted patency in both groups (endoscopic, P = .02; open, P = .02) and decreased secondary patency in the open harvest group (P = .04).
Endoscopic and open harvest techniques for infrainguinal arterial bypass provide similar rates of wound complications and bypass patency, whereas hemodialysis negatively affects patency after both harvest methods. Endoscopic harvest is associated with the need for less perioperative narcotics, suggesting a potential benefit of endoscopic harvest that deserves further study.
用于下肢动脉旁路术的内镜下大隐静脉采集可减少切口长度，最初被证明可降低伤口并发症而不影响通畅率。然而，最近的研究表明通畅率较低，且没有伤口并发症获益。我们旨在进一步明确内镜采集与下肢动脉旁路术中的开放采集相比，在伤口并发症和通畅率方面的差异。
分析了 2000 年至 2011 年期间进行的下肢动脉旁路术。仅纳入使用单一节段大隐静脉的病例。根据内镜或开放采集将病例分组，并按体重指数和糖尿病进行频数匹配。比较基线特征。进行单变量和多变量分析，以确定基线数据和采集方法与伤口并发症和通畅率的相关性。
该研究纳入了 76 例旁路术；内镜采集组 35 例，开放采集组 41 例。内镜采集组和开放采集组的基线特征除内镜采集组的平均年龄较大和开放采集组的颈动脉疾病更为常见外，无显著差异。30 天伤口并发症发生率（29%比 27%；P=.87）或其他围手术期变量在内镜采集组和开放采集组之间无显著差异，除内镜采集组的麻醉药物使用减少（P=.01）外。平均随访 747 天。内镜采集组和开放采集组的 3 年原发性通畅率（47%比 49%；P=.8）、3 年原发性辅助通畅率（88%比 73%；P=.1）或 3 年继发性通畅率（92%比 76%；P=.09）均无显著差异。高体重指数提高了内镜采集组的原发性通畅率（P=.02），但对开放采集组的通畅率无影响（P=.15）。需要血液透析的患者在两组中均增加了原发性辅助通畅率丧失的风险（内镜组，P=.02；开放组，P=.02），且开放采集组的继发性通畅率降低（P=.04）。
下肢动脉旁路术的内镜下和开放采集技术提供了相似的伤口并发症和旁路通畅率，而血液透析会对两种采集方法后的通畅率产生负面影响。内镜采集与围手术期麻醉药物需求减少相关，提示内镜采集具有潜在获益，值得进一步研究。
