A Comparison of Endovascular Assisted and Conventional In Situ Bypass Grafts

Thirty-three in situ saphenous vein bypass grafts were performed using a conventional open technique (Cl) 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 Cl and EAI patients was, respectively, 8.4 ± 2.0 days and 4 ± 1.6 days. Missed arteriovenous fistulas were noted in one Cl and 17 EAI limbs postoperatively. At follow-up four (12%) Cl and six (19%) EAI grafts were occluded or had undergone revision surgery. Based on life-table analysis Cl 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 Cl patency is comparable. Ultimately long-term patency will be the crucial test for determining the utility of this new technique.