title: A new "closed" in situ vein bypass technique results in a reduced wound complication rate.
abstract: OBJECTIVE
  This prospective randomised multicentre trial was conducted to test whether a new "closed" technique for in situ vein bypass would result in a lower frequency of wound complications, without negative effects on patency rates and without an intolerable increase in residual arteriovenous fistulae compared to the conventional "open" technique.
  
  
  METHODS
  We have developed a new "closed" technique using a co-axial catheter embolisation system for intra-operative coil embolisation of side branches, in order to avoid long incisions.
  
  
  METHODS
  In four centres and 95 patients, 97 in situ bypasses were performed: 47 "closed" and 50 "open". Randomisation was stratified for below knee femoropopliteal bypasses (60) and femorocrural bypasses (37). Indications were disabling intermittent claudication (29), restpain (26) or ulcers and/or necrosis (42).
  
  
  RESULTS
  Postoperative mortality was 2% (one in the "closed", one in the "open" group). A total number of 16 (34%) wound complications (grade 1, 2 and 3) occurred in the closed group compared to 36 (72%) in the open group (p < 0.05). Deep wound complications (grade 2) occurred in six patients (13%) of the "closed" group, compared to 15 (30%) in the "open" group. In both groups, three patients (6%) developed deep wound complications including the bypass area (grade 3). In the "closed" group, 20 patients needed additional treatment for arteriovenous fistulae, compared to four in the "open" group. One-year patency rates did not show a statistically significant difference: primary patency rates were 65% and 61% and secondary patency rates were 86% and 76% respectively for the "closed" and "open" group.
  
  
  CONCLUSIONS
  These results indicate that a "closed" technique reduces wound complication rate, without negative effects on the short term patency rates. The "closed" technique results in an increased number of postoperative treatments for residual arteriovenous fistulae.
authors.affiliation: Department of Vascular Surgery, University Hospital Rotterdam Dijkzigt, The Netherlands.
authors.forename: L C
authors.initials: LC
authors.lastname: van Dijk
authors.forename: H
authors.initials: H
authors.lastname: van Urk
authors.forename: N A
authors.initials: NA
authors.lastname: du Bois
authors.forename: T I
authors.initials: TI
authors.lastname: Yo
authors.forename: J
authors.initials: J
authors.lastname: Koning
authors.forename: W B
authors.initials: WB
authors.lastname: Jansen
authors.forename: C H
authors.initials: CH
authors.lastname: Wittens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency; D014945:Wound Healing