Objective: The impact of great saphenous vein harvest technique on infrainguinal bypass outcomes remains a matter of debate, with no robust evidence favoring a specific technique over the other. This study aims to compare the outcomes of open vein harvest with endoscopic vein harvest in patients undergoing infrainguinal bypass surgery.
Methods: Patients who underwent an infrainguinal bypass from a femoral origin using a single-segment great saphenous vein between 2011 and 2023 were identified in the Vascular Quality Initiative infrainguinal bypass module. Only patients undergoing a bypass for peripheral artery disease were included, and those undergoing in-situ bypass were excluded. Patients were then classified according to their vein harvest technique into open vein harvest and endoscopic vein harvest groups. Three-to-one nearest-neighbor propensity score matching without replacement was performed to ensure balance of covariates between the two comparison groups. Kaplan-Meier and Cox-regression analysis were used to estimate long-term event rates and evaluate the association of vein harvest technique with the primary outcomes of primary patency, primary-assisted patency, secondary patency, re-intervention, amputation, and major adverse limb events, defined as the composite outcome of amputation and/or re-intervention.
Results: 7,929 patients who underwent open vein harvest were matched to 2,643 patients who underwent endoscopic vein harvest. All baseline characteristics, demographics, and operative details were balanced after propensity score matching. Endoscopic vein harvest had a significantly lower rate of surgical site infections (1.8% vs 2.9%, p=0.003), whereas other peri-operative outcomes including graft infection (p=0.12), myocardial infarction (p=0.16), stroke (p=0.13), and return to operating room (0.14) were similar between the two groups. At 1-year follow up, open vein harvest patients had a significantly higher primary patency (71% vs 65%, p<0.001), primary-assisted patency (86% vs 81%, p<0.001), and secondary patency (90% vs 85%, p<0.001), and significantly lower rates of amputation (6% vs 9%, p<0.001), re-intervention (20% vs 25%, p<0.001), and major adverse limb events (25% vs 30%, p<0.001) compared to endoscopic vein harvest patients. The primary patency of endoscopic vein harvest bypasses significantly increased from 59% to 70% between 2011 and 2020 (p=0.042). While open vein harvest had a significantly higher primary patency compared to endoscopic vein harvest in 2011-2012 (72% vs 59%, p=0.006), this difference diminished over time with no significant difference observed in the most recent interval (2019-2020) studied (73% vs 70%, p=0.214).
Conclusion: While endoscopic vein harvest is associated with a lower post-operative wound complication rate, open vein harvest conferred superior long-term outcomes of patency, re-intervention, and limb salvage over the study period. Nonetheless, endoscopic vein harvest has demonstrated improvements in primary patency over the years, significantly narrowing the gap in this outcome between the two harvest methods.
Keywords: Endoscopic Vein Harvest; Great Saphenous Vein; Infrainguinal Bypass; Open Vein Harvest; VQI.
Copyright © 2024. Published by Elsevier Inc.