Minimally invasive distal limb bypasses. Techniques and results

As endovascular procedures increasingly become the procedures of choice for limb salvage, a subset of patients remains that requires open arterial reconstruction due to anatomic or pathologic reasons. Traditional greater saphenous vein harvest performed during open bypass for peripheral occlusive arterial disease is associated with long surgical incisions, increased operative times devoted to wound closure, and wound complications such as infection and dehiscence. Endoscopic conduit harvest, used with excellent results in coronary artery bypass surgery, can also be used in minimally invasive arterial bypass for limb salvage with certain technical modifications. These approaches to complex limb salvage procedures may result in shortened operating room time, shorter length of stay, reduced readmissions for wound complications, and ultimately, decreased costs to the health care system. The treating surgeon must continue to stay up to date with these approaches and be aware of pertinent issues regarding open and minimally invasive arterial interventions, as well as endovascular approaches.