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A comparison of endovascular assisted and conventional in situ bypass grafts
D F Cikrit1, N F Fiore, M C Dalsing
1Department of Surgery, Indiana University Medical Center, Indianapolis 46202, USA.
Insights
Endovascular arterial reconstruction (EAI) bypass grafting shows comparable patency to conventional open techniques (CI). EAI reduces hospitalization and incision length but increases arteriovenous fistula complications.
Area of Science:
- Vascular Surgery
- Endovascular Techniques
- Bypass Grafting
Background:
- Conventional open in situ saphenous vein bypass grafting (CI) is a standard treatment for peripheral artery disease.
- Endovascular occlusion of side branches (EAI) is a newer technique aiming to improve outcomes.
Purpose of the Study:
- To compare the outcomes of EAI bypass grafting with CI for femoropopliteal or trifurcation artery bypass.
- To evaluate differences in complications, hospitalization, and graft patency between the two techniques.
Main Methods:
- A comparative study of 33 CI and 31 EAI in situ saphenous vein bypass grafts.
- Grafts were performed from the femoral to the popliteal or trifurcation artery for various stages of peripheral artery disease.
- Outcomes assessed included wound complications, postoperative hospitalization, missed arteriovenous fistulas, and graft patency at 18 months.
Main Results:
- EAI bypass grafting resulted in significantly shorter postoperative hospitalization (4 days vs. 8.4 days) and shorter surgical incisions.
- Wound complications were less frequent in EAI (4 limbs) compared to CI (11 limbs).
- However, missed arteriovenous fistulas were significantly higher in EAI (17 limbs) compared to CI (1 limb).
- Eighteen-month cumulative patency rates were comparable: 79% for CI and 83% for EAI.
Conclusions:
- EAI bypass grafting offers comparable long-term patency to conventional open techniques.
- EAI significantly reduces postoperative hospitalization and incision length.
- The increased incidence of missed arteriovenous fistulas with EAI requires further investigation and management strategies.
Abstract:
Thirty-three in situ saphenous vein bypass grafts were performed using a conventional open technique (CI) while 31 in situ bypass grafts were performed using endovascular occlusion of side branches (EAI). Bypass grafts were performed from the femoral to the popliteal (n = 37) or a trifurcation (n = 27) artery for claudication (n = 7), rest pain (n = 14), or tissue loss (n = 43). Wound complications developed in 11 Cl and four EAI limbs. Postoperative hospitalization in CI and EAI patients was, respectively, 8.4 +/- 2.0 days and 4 +/- 1.6 days. Missed arteriovenous fistulas were noted in one CI and 17 EAI limbs postoperatively. At follow-up four (12%) CI and six (19%) EAI grafts were occluded or had undergone revision surgery. Based on life-table analysis CI and EAI cumulative patency rates at 18 months were 79% and 83%, respectively. Although this new technique (EAI bypass grafting) did not reduce operative time, it did decrease the length of surgical incisions and the duration of postoperative hospitalization (p < 0.001, Student's t test). Wound complications occurred less frequently in EAI limbs but the incidence of missed arteriovenous fistulas was significantly higher. These data suggest that EAI and CI patency is comparable. Ultimately long-term patency will be the crucial test for determining the utility of this new technique.