title: Femoral-popliteal bypass with endoscopically harvested saphenous vein in patients with TASC D disease of the superficial femoral artery.
abstract: BACKGROUND
  This study evaluated patients undergoing femoropopliteal bypasses using endoscopically harvested vein to treat Trans-Atlantic Inter-Society Consensus (TASC) stage D lesions. Primary patency and primary assisted patency were evaluated, as were perioperative morbidity and mortality and hospital length of stay (LOS). Results for this minimally invasive alternative to femoropopliteal bypass with conventional open vein harvesting were analyzed.
  
  
  METHODS
  A retrospective analysis was performed on patients who underwent femoral-popliteal bypass with endoscopic saphenous vein harvest and angiographic TASC D anatomy. Postoperative duplex exams were evaluated, and the study end points of graft thrombosis or the development of a high-grade stenosis prompting reintervention were sought. Patient demographics, morbidity, mortality, and hospital LOS were analyzed.
  
  
  RESULTS
  Twenty-seven patients meeting our inclusion criteria underwent surgery between June 2002 and June 2007. Indications for surgery in these patients were claudication (n=10), gangrene or ulceration (n=9), and ischemic rest pain (n=8). Fifty-two percent of the patients were male, 50% had cardiac disease, 65% had hypertension, 54% were diabetic, and 65% had a significant smoking history. Median LOS was 2.5 days in claudicants, 3.0 days in patients with rest pain, and 7.0 days in patients with gangrene or ulceration (p<0.05). Kaplan-Meier primary patency and primary assisted patency rates were 73.2% and 80.8% at 1 year, respectively; and these rates were maintained for 70 months. The only perioperative complication was a superficial wound infection, and two patients died during follow-up from causes unrelated to the surgery.
  
  
  CONCLUSIONS
  Femoropopliteal bypass using endoscopic vein harvest is a durable reconstructive vascular procedure which can be performed with minimal postoperative morbidity, short LOS, and satisfactory long-term patency.
authors.affiliation: Division of Vascular Surgery, Winthrop University Hospital, Mineola, NY 11501, USA. ghines@winthrop.org
authors.forename: George L
authors.initials: GL
authors.lastname: Hines
authors.forename: Reese A
authors.initials: RA
authors.lastname: Wain
authors.forename: Joann
authors.initials: J
authors.lastname: Montecalvo
authors.forename: Martin
authors.initials: M
authors.lastname: Feuerman
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009518:New York; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality