title: Endoscopic vein harvesting in lower extremity arterial bypass: a systematic review.
abstract: OBJECTIVE
  Endoscopic vein harvesting (EVH) for arterial bypass surgery may be associated with lower wound complication rates than open vein harvesting (OVH), but other long-term outcomes remain controversial, and there are concerns that graft patency may be poorer after EVH compared with OVH. We conducted a systematic review of all available evidence for EVH in lower extremity arterial bypass (LEAB).
  
  
  METHODS
  A literature search of Medline, Embase, Ovid and Cochrane databases between 1996 and 2013 was performed using the terms "endoscopic vein harvesting", "minimally invasive vein harvest", "peripheral bypass surgery", and "lower extremity bypass surgery", and detailed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Primary outcomes were graft patency and overall wound complication rates. Secondary outcomes were wound infection, length of hospital stay, and cost-effectiveness. Summary estimates were calculated by random effects meta-analysis if sufficient data were available.
  
  
  RESULTS
  We identified 18 cohort studies and case series, with considerable clinical heterogeneity, including 2,343 patients. Meta-analysis of six studies revealed a significantly reduced rate of primary patency after EVH (hazard ratio 1.29, 95% confidence interval [CI] 1.03-1.63), with no significant difference between EVH and OVH with respect to wound infection in 12 studies (odds ratio 0.81, 95% CI 0.61-1.08). There was a lack of strong evidence to support the secondary outcomes of EVH.
  
  
  CONCLUSIONS
  EVH reduces primary patency rates after LEAB, but does not demonstrate an advantage with respect to postoperative wound complications. However, the available data are heterogeneous, and uncertainty is introduced by both evolution in technology and increasing technical experience. EVH should be used with caution and in the context of formal research.
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: Y A
authors.initials: YA
authors.lastname: Jauhari
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: C O
authors.initials: CO
authors.lastname: Hughes
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Black
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: K G
authors.initials: KG
authors.lastname: Jones
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: St Georges Vascular Institute, 4th Floor, St James' Wing, St Georges Hospital NHS Trust, London, UK. Electronic address: alankarthi@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
mesh_terms: D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000009:adverse effects / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000637:transplantation
keywords: Arterial bypass; Endoscopic; Endovascular; Lower limb; Patency; Systematic review; Vein harvest; Wound healing