title: "Over-the-wire" inversion saphenectomy: a simple, minimally invasive vein harvesting technique for arterial bypass.
abstract: OBJECTIVE
  To examine the feasibility and clinical outcome of a novel, minimally invasive technique for harvesting the great saphenous vein (GSV) for use in peripheral arterial bypass surgery.
  
  
  METHODS
  Between May 2001 through March 2003, 27 patients (15 men; mean age 71+/-10 years) underwent extremity bypass procedures for limb salvage (88%) or disabling claudication (12%) using the inversion technique to harvest the GSV. The veins were turned "inside out" using a unique catheter and guidewire system. With the endothelial surface exposed, valve leaflets were excised, and adherent thrombus was washed away. Veins were inverted again to turn the endothelial surface back inside the lumen for use as a bypass conduit.
  
  
  RESULTS
  Inversion vein harvesting and arterial bypass were completed in 24 (89%) of 27 patients; 2 patients were treated with synthetic grafts because of small GSVs. Another patient was found after vein harvesting to have inadequate arterial outflow despite a good quality conduit. The average vein length was 45+/-10 cm; a mean 4+/-1 incisions were made, including those for arterial exposure. Incisions made to divide vein tributaries averaged 2 cm in length. Duration of vein harvesting was 25 minutes (range 5-80). Wound complications were minor (2 hematomas, 2 cases of erythema, 2 seromas). Of 6 grafts that occluded after 30 days, 5 involved small-diameter vein grafts (< 3.5 mm). At a mean 12 months, primary and assisted primary graft patency rates were 88% (14/16) and 94% (15/ 16), respectively, for grafts with minimum diameters > or = 4 mm versus 38% (3/8) primary patency for veins < 4 mm (n = 8, p < 0.001). The limb salvage rate was 92% (22/24).
  
  
  CONCLUSIONS
  Over-the-wire inversion saphenectomy is a simple and reliable minimally invasive technique for arterial bypass. Incisions are small and cosmetically superior to those of the traditional long incision method. One-year follow-up suggests that grafts harvested by inversion technique have excellent durability when the minimum vein diameter is > or = 4 mm, as determined by preoperative vein mapping.
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, California 94305-5642, USA. bhill@stanford.edu
authors.forename: Bradley B
authors.initials: BB
authors.lastname: Hill
authors.forename: Rishad M
authors.initials: RM
authors.lastname: Faruqi
authors.forename: Frank R
authors.initials: FR
authors.lastname: Arko
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Zarins
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fogarty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000792:Angiography; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex