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Updated: Aug 5, 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
Endoscopically-assisted in-situ lower limb arterial reconstruction is safe and effective: A retrospective cohort
Sarah Klapman1, Aidan M Kirkham2,3,4, Johann Licht2
1Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Objective:
Compared with the traditional open approach, minimally invasive vascular surgery techniques may offer benefits to patients undergoing lower-extremity arterial reconstruction. We sought to determine whether endoscopically-assisted in-situ lower-extremity bypass for chronic limb-threatening ischemia is as safe and effective as traditional approaches.
Methods:
From 2021 to 2024, we performed a retrospective cohort study of endoscopically-assisted femoropopliteal or femorotibial bypass on 10 patients in an academic hospital in Ontario, Canada. Patients were selected based on the presence of Rutherford grade 4 to 6 ischemia and anatomic suitability for in-situ bypass, aged over 18 years, and ability to tolerate surgery; no patients withdrew from the study but one died of unrelated causes before reaching the 1-year mark after surgery. We recorded patient demographics such as medical comorbidities (such as diabetes and coronary artery disease). We also documented outcomes (such as 1-year amputation-free survival, major adverse cardiac or limb events, and major revascularization). Follow-up with arterial duplex scanning was performed at 1 and 3 months, and then yearly after surgery; data were collected up to 1 year after surgery.
Results:
The mean age of patients was 72.4 years, with 70% males. The amputation-free survival at 1-year was 80%. The 30-day mortality was 0.0%, whereas the 1-year mortality was 10.0%, with the only mortality being secondary to a new diagnosis of gastric cancer. At 1-year follow-up, the primary, primary-assisted, and secondary patency rates were 66.7%, 88.9%, and 100%, respectively. There were no major adverse cardiac events at 30-day or 1-year. No postoperative bleeding events requiring intervention or residual arteriovenous fistulas were identified on surveillance imaging. The median hospitalization length of stay was 4.4 days (1-11).
Conclusions:
Our outcomes suggest that endoscopically-assisted lower-extremity bypass for chronic limb-threatening ischemia is safe and effective in a select patient population with chronic limb-threatening ischemia.