Endoscopic Saphenous Vein Harvesting with the Reusable KARL STORZ Retractor System for a Lower Extremity Bypass

Abstract

Saphenous vein grafts have been established as the gold standard conduit for below-knee bypass grafting. Conventional open vein harvest involves either one long incision or multiple small incisions, both of which leave skin bridges along the length of the vein. Endoscopic saphenous vein harvesting (EVH) has been widely accepted for coronary artery bypass grafting. EVH is advantageous because it results in less wound morbidity and has better cosmetic results than open vein harvesting. We applied EVH with the reusable KARL STORZ retractor system to a lower extremity bypass. A 75-year-old man was admitted to the hospital for an unhealed foot ulcer for 6 months. He was being treated by an orthopedist for pain in the right lower extremity for several years, and the wound ulcerated after a callus resection. The ankle branchial index was 0.41, and skin perfusion pressure was 26 mmHg and 24 mmHg at the dorsal and plantar regions, respectively, of the right foot. A computed tomography scan showed occlusion of the distal superficial femoral and popliteal arteries. A right femoral below-knee popliteal artery bypass was performed 3 days after admission for the right foot with severe ischemia. The postoperative course was uneventful. Four days after the operation, he was discharged with no pain and the ulcer was healing.