Available saphenous harvest techniques and their influence on infrainguinal bypass patency and wound-related complications

Abstract

IntroductionThe great saphenous vein (GSV) is the preferred conduit for infrainguinal arterial bypass procedures, due to its long-term patency and resistance to infection. However, traditional harvesting methods, including open vein harvesting (OVH) with continuous or skip incisions, pose significant risks of wound complications, with reported rates as high as 40%. To address these issues, minimally invasive techniques such as endoscopic vein harvesting (EVH) have emerged, promising reduced complications while maintaining graft integrity. This comprehensive review synthesises the current literature on various saphenous harvesting techniques, evaluating their impact on graft patency and postoperative complications.MethodsA systematic electronic literature search was conducted using PubMed and Embase, focussing on articles published between 2013 and 2023. The search utilised keywords related to infrainguinal bypass, saphenous vein harvesting, and associated complications. Nine relevant studies were selected for analysis, assessing outcomes related to different harvesting techniques.ReviewThe reviewed studies present mixed results regarding wound complications and graft patency. Wartman et al. found comparable 30-day wound complication rates between EVH and OVH (29% vs 27%), with no significant differences in long-term patency rates. In contrast, Eid et al. reported significantly higher wound infections in the OVH group (20.4% vs 0% in EVH), but OVH demonstrated superior primary patency at 30 months (69.4% vs 43.2% for EVH). Santo et al. supported this, noting better primary patency rates for OVH (71% at one year) compared to EVH (58%). Teixeira et al. found no significant differences in surgical site infections across techniques but highlighted inferior one-year primary patency rates for EVH. Additionally, Mirza et al. corroborated OVH's superior primary patency (62.8% vs 47%). Conversely, Kronick et al. indicated lower wound complications in the EVH group (2% vs 28% for OVH). The systematic review by Jauhari et al. revealed a pooled hazard ratio indicating inferior patency for EVH.Discussion/ConclusionsThe findings indicate that while EVH offers advantages in terms of reduced wound complications, concerns regarding long-term graft patency persist. The data suggest that OVH may provide better primary patency, although both techniques have their unique benefits and drawbacks. Surgical choice should consider patient-specific factors such as comorbidities and anatomical variations. A thorough understanding of these harvesting techniques is essential for improving patient outcomes in infrainguinal bypass surgery. Future research is needed to identify optimal harvesting strategies and enhance the efficacy of vein harvesting techniques, balancing complication rates with graft performance to inform clinical practice.

Keywords: Critical limb ischaemia; graft patency; great saphenous vein; harvest; surgical technique; wound complications.