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Updated: Aug 6, 2026
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Compromised bypass graft outcomes after minimal-incision vein harvest
Rana Pullatt1, Thomas E Brothers, Jacob G Robison
1Department of Surgery, Section of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Insights
Minimal incision vein harvest techniques for lower extremity revascularization showed worse graft patency and limb salvage compared to single incision. These findings question the benefit of limited incisions when outcomes may be compromised.
Area of Science:
- Vascular Surgery
- Minimally Invasive Procedures
- Graft Patency
Background:
- Minimal incision techniques (MIT) for vein harvest aim to reduce wound complications in lower extremity revascularization.
- Long-term data on graft patency and limb salvage with MIT are limited.
Purpose of the Study:
- To compare the long-term outcomes of autogenous reversed great saphenous vein harvest using single incision (SI) versus minimal incision techniques (MIT) with or without endoscopy for lower extremity revascularization.
Main Methods:
- Retrospective case-control study of 324 patients undergoing lower extremity revascularization over 10 years.
- Comparison of SI (n=133), minimal incision without endoscopy (MI, n=106), and minimal incision with endoscopy (MIE, n=85).
- Primary outcomes: graft patency (Kaplan-Meier). Secondary outcomes: limb salvage and wound complications.
Main Results:
- Single incision (SI) showed significantly better 5-year primary patency (59%) compared to MI (33%) and MIE (44%).
- Secondary patency was also better with SI (66%) versus MI (47%), but not MIE (58%).
- No significant differences in 5-year limb salvage or wound complication rates were observed across the techniques.
Conclusions:
- Graft patency and limb salvage declined with the adoption of minimal incision techniques (MI/MIE) for great saphenous vein harvest.
- Concerns are raised regarding the advisability of limiting incision extent at the potential cost of compromised vascular surgery outcomes.
Background:
Minimal incision techniques for vein harvest may lessen wound complications after lower extremity revascularization, but long-term patency and limb salvage data are limited.
Methods:
This retrospective case-control study used a computerized vascular registry set in an academic vascular surgical practice. All patients undergoing lower extremity revascularization using autogenous reversed great saphenous vein by a single vascular surgeon in a 10-year period were reviewed. Harvest of great saphenous vein via long single incision (SI) in 133 patients was compared with minimal incisions with endoscopy (MIE) in 85, or MI without endoscopy in 106. The main outcome measures were primary and secondary graft patency by Kaplan-Meier life-table analysis and cumulative sum failure (CUSUM). Secondary outcomes of interest were limb salvage and wound complications.
Results:
No differences were observed between MIE, MI, and SI patients for demographic data, risk factors, or primary indications, including claudication, rest pain, ischemic ulcer, and gangrene. Endoscopic vein harvest patients were significantly more likely than MI or SI to be women and more likely to use tobacco. Primary patency at 5 years was better after SI vein harvest (59%) than with either MI (33%, P = .004) or MIE (44%, P = .045) techniques, although both MI groups had a higher proportion of bypass grafts to the popliteal artery. Similarly, cumulative secondary patency was better after SI (66%) than with MI (47%, P = .045), but not MIE (58%, P = .45). Differences in limb salvage at 5 years in SI (73%) were not statistically superior to either MI (59%, P = .24) or MIE (58%, P = .13). No learning curve for MI or MIE vein grafts was evident by CUSUM for primary patency at 12 months. No differences in wound complication rates were observed for SI (9%), MI (10%), or MIE (6%) grafts (P = .54).
Conclusions:
Graft patency and limb salvage deteriorated during the time when MI or MIE techniques of great saphenous vein harvest were adopted. This observation raises concern about the advisability of limiting the extent of the incision at the potential cost of compromised outcomes without an obvious advantage in limiting wound complications.
