Vein harvest technique is not associated with major adverse limb events

The benefits of vein conduits in lower extremity bypass (LEB) are known, but there is debate about the optimal harvest technique. We aimed to compare the impact of conduit harvest on major adverse limb events (MALEs) and MALE-free survival (MFS).

We conducted a retrospective review of lower extremity bypass patients with vein from 2013 to 2022 at our single-center institution. Patients were divided into two groups: endoscopic vascular vein harvest (EVH) (n = 80) and open vein harvest (OVH) (n = 204). The primary end points were MALEs and MFS, and secondary endpoints included 30-day infection rate (IR), operative time, discharge status, postoperative length of stay (LOS), and estimated blood loss. MALEs and MFS were compared using log ranks and Kaplan-Meier analysis. Adjusted analyses to determine factors associated with MALEs and MFS at 1 and 3 years were performed.

At 1 and 3 years, MALEs and MFS were not statistically different. At 1 year, EVH MALE was 35% vs 37% for OVH (P = .871), and at 3 years, it was 61% vs 55% (P = .434). At 1 year, EVH MFS was 63% vs 65% for OVH (P = .434), and at 3 years it was 39% vs 45% (P = .44) . There were no significant differences in the 30-day IR (1.25% vs 3.88%; P = .30), estimated blood loss (397.31 ± 336.00 vs 479.57 ± 493.81 mL; P = .12), discharge home vs other facility (88.61% vs 85.92%; P = .63), or LOS (7.09 ± 4.98 vs 7.92 ± 6.24 days; P = .30). On adjusted analyses, harvest technique was not associated with MALEs or MFS at 1 and 3 years. Adjusted analyses revealed no association between vein harvest technique and MALEs at 1 year. It did show significant differences in MALEs at 1 year for bypasses whose proximal anastomoses originated in the below-knee popliteal and tibial artery segments (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.30-4.80; P = .01) and bypasses that consisted of two or more vein segments (HR, 1.86; 95% CI, 1.25-2.76; P < .01); both findings were still significant at 3 years and neither were associated with vein harvest technique. There were no comorbidities that affected MALEs at 1 year, but at 3 years MALEs were associated with chronic obstructive pulmonary disease (HR, 1.46; 95% CI, 1.08-1.99; P = .02) and diabetes (HR, 1.51; 95% CI, 1.12-2.03; P = .01). There were no variables associated with a return to the operating room except for female sex (odds ratio, 2.317; 95% CI, 1.214-4.424; P = .011). There was still no difference in 30-day IR even after adjusted analysis.

Although EVH is not associated with improved IRs and LOS, this technique does not affect MALEs or MFS compared with OVH. Economic impact and patient satisfaction of EVH require further studies to define the role of less invasive approaches to vein harvest.