Abstract
Objectives: Arterial reconstruction of the lower extremity with an in situ greater saphenous vein is an important method for limb salvage surgery. In this procedure, multiple skip incisions along the saphenous vein are usually necessary for side branch occlusion. This procedure is fraught with hazards for wound complications and cosmetic problems. In this study, we used endoscopic vein harvest equipment to minimize these complications. Methods: We performed femoral to infragenicular artery in situ bypass with an endoscopic-assisted technique. Only two small skin incisions for arterial access were needed. Through these incisions, an endoscopic vein harvest system was inserted subcutaneously along the saphenous vein to locate and seal all of its side branches. After completion of the proximal anastmosis, the valves were lysed through the distal end of the saphenous vein with a flexible valvulotomy cutter. Then distal anastmosis was completed. Results: From August 2008 through June 2012, five patients were operated on using this method. All the patients were male, with ages ranging from 44–72 years (62.8±11.4). In all cases, intermittent claudication disappeared after the operation. In one case, emergent thrombectomy was needed on the same day after the operation. There were no wound complications (infection, hematoma, cellulitis, pain, etc). In two cases, swelling of the lower extremity after reperfusion resulted in a long hospital stay. One in situ bypass was occluded three years after the operation with rich collateral pathways without ischemic symptoms. The other in situ bypasses have remained patent during follow-up periods ranging from 11–57 months. Conclusion: Endoscopically assisted in situ greater saphenous vein side branch occlusion provides safe and effective results without wound complications.
