Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
J Vasc Surg. 2018 Apr;67(4):1199-1206. doi: 10.1016/j.jvs.2017.08.084.
Conflicting data exist on outcomes of open vein harvest (OVH) and endoscopic vein harvest (EVH) for infrainguinal bypass. The purpose of this study was to compare outcomes between OVH and EVH in femoral to popliteal artery bypasses.
A retrospective review was performed of all patients undergoing common femoral to popliteal artery bypass with great saphenous vein between January 1997 and June 2014. Bypasses using arm or composite vein were excluded, as were those performed for popliteal artery aneurysms or trauma. Harvest was typically performed by dedicated surgical assistants. Patients were analyzed by either OVH or EVH of vein. The primary outcome was primary patency. Secondary outcomes included assisted primary and secondary patency and major wound complications. Statistical analysis was performed for categorical and continuous variables with life-table and survival statistics for long-term outcomes.
In the study time, 505 patients underwent femoral-popliteal bypass; 262 patients and 280 limbs met the inclusion criteria. OVH was performed on 194 (69%) limbs and EVH on 86 (31%). There was no significant difference between the groups in terms of demographics, comorbidities, and preoperative Rutherford classification. Mean follow-up was 34 months. Six of 13 operators (46%) used both harvest techniques. At 5 years, OVH demonstrated higher rates of primary patency compared with EVH (62.8% vs 47%; P = .006) and higher rates of assisted primary patency (81.2% vs 64.3%; P = .003). Secondary patency was not significantly different between groups. The average number of graft interventions was less frequent with EVH, although this trend was not statistically significant (0.1 OVH vs 0.3 EVH; P = .1). EVH also had a lower rate of major wound complications per limb (n = 16; 8% OVH vs 0% EVH; P = .004).
OVH was associated with superior primary and assisted primary patencies compared with EVH at 5 years, yet OVH was associated with higher wound complications. Surgeons should weigh the risk of wound complications vs decreased primary and primary assisted patency when deciding which method to use for vein harvest.
关于股腘旁路中切开静脉采集（OVH）和内镜静脉采集（EVH）的结果存在相互矛盾的数据。本研究的目的是比较股腘旁路中 OVH 和 EVH 的结果。
对 1997 年 1 月至 2014 年 6 月期间所有接受大隐静脉行股总动脉至腘动脉旁路手术的患者进行回顾性分析。排除使用臂或复合静脉的旁路手术，以及用于治疗腘动脉动脉瘤或创伤的旁路手术。采集通常由专门的手术助手进行。根据是否进行 OVH 或 EVH 采集静脉对患者进行分析。主要结果是一期通畅率。次要结果包括辅助一期和二期通畅率以及主要伤口并发症。使用寿命表和生存统计数据对长期结果进行分类和连续变量的统计分析。
在研究期间，505 例患者接受了股腘旁路手术；262 例患者和 280 条肢体符合纳入标准。194 条（69%）肢体行 OVH，86 条（31%）肢体行 EVH。两组在人口统计学、合并症和术前 Rutherford 分类方面无显著差异。平均随访时间为 34 个月。13 名术者中有 6 名（46%）同时使用了两种采集技术。5 年时，与 EVH 相比，OVH 显示出更高的一期通畅率（62.8%比 47%；P=.006）和更高的一期辅助通畅率（81.2%比 64.3%；P=.003）。两组间二期通畅率无显著差异。虽然 EVH 的平均移植物干预次数较少，但这一趋势无统计学意义（0.1 OVH 比 0.3 EVH；P=.1）。EVH 每条肢体的主要伤口并发症发生率也较低（16 例；8%OVH 比 0%EVH；P=.004）。
与 EVH 相比，5 年时 OVH 与更高的一期和一期辅助通畅率相关，但 OVH 与更高的伤口并发症相关。当决定使用哪种方法采集静脉时，外科医生应权衡伤口并发症的风险与一期和一期辅助通畅率的降低。
