A comparison of endovascular assisted and conventional in situ bypass grafts.
Thirty-three in situ saphenous vein bypass grafts were performed using a conventional open technique (CI) while 31 in situ bypass grafts were performed using endovascular occlusion of side branches (EAI). Bypass grafts were performed from the femoral to the popliteal (n = 37) or a trifurcation (n = 27) artery for claudication (n = 7), rest pain (n = 14), or tissue loss (n = 43). Wound complications developed in 11 Cl and four EAI limbs. Postoperative hospitalization in CI and EAI patients was, respectively, 8.4 +/- 2.0 days and 4 +/- 1.6 days. Missed arteriovenous fistulas were noted in one CI and 17 EAI limbs postoperatively. At follow-up four (12%) CI and six (19%) EAI grafts were occluded or had undergone revision surgery. Based on life-table analysis CI and EAI cumulative patency rates at 18 months were 79% and 83%, respectively. Although this new technique (EAI bypass grafting) did not reduce operative time, it did decrease the length of surgical incisions and the duration of postoperative hospitalization (p < 0.001, Student's t test). Wound complications occurred less frequently in EAI limbs but the incidence of missed arteriovenous fistulas was significantly higher. These data suggest that EAI and CI patency is comparable. Ultimately long-term patency will be the crucial test for determining the utility of this new technique.
Cikrit
D F
DF
Department of Surgery, Indiana University Medical Center, Indianapolis 46202, USA.
Fiore
N F
NF
Dalsing
M C
MC
Lalka
S G
SG
Sawchuk
A P
AP
Ladd
A P
AP
Dodson
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006083:Graft Occlusion, Vascular; D006801:Humans; D007902:Length of Stay; D008297:Male; D008722:Methods; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D012501:Saphenous Vein / Q000601:surgery*; D014654:Vascular Patency