title: Assessing outcomes, costs, and benefits of emerging technology for minimally invasive saphenous vein in situ distal arterial bypasses.
abstract: BACKGROUND
  Instrumentation for a minimally invasive angioscopic in situ peripheral arterial bypass (MIAB) with catheter-directed side-branch occlusion has recently been approved for use. Despite the attractiveness of this approach (2 short incisions), benefits such as lower morbidity and shorter hospitalizations remain undocumented. To justify wide acceptance, minimally invasive surgical techniques must match conventional procedures in durability and cost while enhancing patient comfort. Often such comparisons are difficult during the implementation phase of a new procedure.
  
  
  OBJECTIVE
  To compare the outcomes of the MIAB procedures with a concurrent group of patients undergoing conventional in situ bypass procedures.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  The first 20 consecutive MIAB procedures in 19 patients performed between August 1, 1995, and July 31, 1997, were compared with 19 contemporaneous consecutive conventional in situ bypass procedures performed at the same institution.
  
  
  METHODS
  Operative time, postoperative length of stay, hospital costs, complications, primary assisted and secondary patency, limb salvage, and survival.
  
  
  RESULTS
  The patient groups were comparable with respect to age, sex, incidence of smoking, coronary artery disease, hypertension, diabetes, renal failure, cerebrovascular disease, indication, and distal anastomosis level. The median operative time was significantly greater for the MIAB group (6.6 hours vs 5.7 hours; P=.009), and intraoperative completion arteriography more frequently showed retained arteriovenous fistulas in the MIAB group (55% vs 21%; P=.05). The median postoperative length of stay and total cost were 6.5 days and $18,000 for the MIAB group and 8 days and $27,800 for the conventional group (P > or = .05). There were no significant differences in major complications (10% in the MIAB group vs 11% in the conventional group), wound complications (10% vs 11%, respectively), primary assisted patency at 1 year (68%+/-11% vs 78%+/-10%, respectively), secondary patency at 1 year (79%+/-10% vs 88%+/-8%, respectively), limb salvage at 1 year (85%+/-10% vs 94%+/-6%, respectively), or patient survival at 1 year (89%+/-8% vs 61%+/-13%, respectively).
  
  
  CONCLUSIONS
  Patients undergoing the MIAB procedure avoided lengthy vein exposure incisions without sacrificing short-term results. There was a trend toward decreased hospital stay and cost, which may be further realized as the clinical experience broadens. Although longer follow-up and larger cohorts will always be required to define durability, immediate access to outcomes and costs on small numbers of patients facilitates the early assessment of emerging technology.
authors.affiliation: Department of Surgery, University of Chicago, IL 60637, USA.
authors.forename: G
authors.initials: G
authors.lastname: Piano
authors.forename: L B
authors.initials: LB
authors.lastname: Schwartz
authors.forename: L
authors.initials: L
authors.lastname: Foster
authors.forename: H S
authors.initials: HS
authors.lastname: Bassiouny
authors.forename: J F
authors.initials: JF
authors.lastname: McKinsey
authors.forename: D
authors.initials: D
authors.lastname: Rosenthal
authors.forename: B L
authors.initials: BL
authors.lastname: Gewertz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D016019:Survival Analysis; D013673:Technology Assessment, Biomedical / Q000191:economics*; D016896:Treatment Outcome; D014481:United States; D014654:Vascular Patency