title: Comparison of Bypass with Endoscopically Harvested Internal Saphenous Vein versus Bypass with Surgically Harvested Internal Saphenous Vein for Lower Limb Arterial Disease.
abstract: BACKGROUND
  Patients with lower limb arterial disease have a high risk for complications related with surgical wounds. The endoscopic extraction of the great saphenous vein (GSV) is a less invasive alternative to the conventional surgical extraction.
  
  
  METHODS
  A clinical and ultrasonographic follow-up was carried out on the lower limb bypass with GSV performed in our institution between years 2007 and 2012. Patients were selected for open or endoscopic harvesting depending on the surgeon assigned (endoscopic or open surgeon). Follow-up was performed at 1, 3, 6, and 12 months after surgery and annually thereafter. All the GSV endoscopic harvestings (GSVEH) were performed by the same surgeon. Data for primary, assisted, and secondary patency and amputation-free survival were analyzed. Anatomopathalogic analysis were performed on pares of samples of the same vein dissected surgically and endoscopically from the same patient.
  
  
  RESULTS
  Sixty bypass surgery has been performed on 60 patients (54 men and 6 women), 30 with GSVEH (50%), and 30 with GSV open harvesting (GSVOH). All patients were intervened for critical limb ischemia (Rutherford cathegory 4, 5, and 6). Significant differences were found between both groups for suture dehiscence (GSVEH 0%, GSVOH 20%, P = 0.01) and infection (GSVEH 3%, GSVOH 30% P, 0.006). No significant differences were found between both groups regarding to primary patency, assisted primary patency, or amputation-free survival. An anatomopathologic comparison of segments of veins extracted surgically and endoscopically of the same patients did not show any significant differences.
  
  
  CONCLUSIONS
  Although no statistically significant differences were found between GSVOH and GSVEH bypass for lower limb revascularization, there is a trend toward poorer patency rates for the endoscopic technique. GSVEH lowers the risks for infection and dehiscence of surgical wounds.
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain. Electronic address: javipeina@me.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Peinado Cebrián
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Flores Herrero
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: Christian Leonel
authors.initials: CL
authors.lastname: Salgado Lopetegui
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Lamarca Mendoza
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Montoya Ching
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: Santiago Estébanez
authors.initials: SE
authors.lastname: Seco
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Leal Lorenzo
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Gil Sales
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Virgen de la Salud Toledo, Toledo, Spain.
authors.forename: Antonio Orgaz
authors.initials: AO
authors.lastname: Pérez-Grueso
mesh_terms: D000671:Amputation, Surgical; D016638:Critical Illness; D018572:Disease-Free Survival; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D061646:Operative Time; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency