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Assessing Outcomes, Costs, and Benefits of Emerging Technology for Minimally Invasive Saphenous Vein In Situ Distal Arterial Bypasses
Giancarlo Piano, MD;
Lewis B. Schwartz, MD;
Lisa Foster, BSN;
Hisham S. Bassiouny, MD;
James F. McKinsey, MD;
David Rosenthal, MD;
Bruce L. Gewertz, MD
Arch Surg. 1998;133:613-618.
Background Instrumentation for a minimally invasive angioscopic in situ peripheral arterial bypass (MIAB) with catheter-directed side-branch occlusion has recently been approved for use. Despite the attractiveness of this approach (2 short incisions), benefits such as lower morbidity and shorter hospitalizations remain undocumented. To justify wide acceptance, minimally invasive surgical techniques must match conventional procedures in durability and cost while enhancing patient comfort. Often such comparisons are difficult during the implementation phase of a new procedure.
Objective To compare the outcomes of the MIAB procedures with a concurrent group of patients undergoing conventional in situ bypass procedures.
Design Retrospective review.
Setting University medical center.
Patients The first 20 consecutive MIAB procedures in 19 patients performed between August 1, 1995, and July 31, 1997, were compared with 19 contemporaneous consecutive conventional in situ bypass procedures performed at the same institution.
Main Outcome Measures Operative time, postoperative length of stay, hospital costs, complications, primary assisted and secondary patency, limb salvage, and survival.
Results The patient groups were comparable with respect to age, sex, incidence of smoking, coronary artery disease, hypertension, diabetes, renal failure, cerebrovascular disease, indication, and distal anastomosis level. The median operative time was significantly greater for the MIAB group (6.6 hours vs 5.7 hours; P =.009), and intraoperative completion arteriography more frequently showed retained arteriovenous fistulas in the MIAB group (55% vs 21%; P=.05). The median postoperative length of stay and total cost were 6.5 days and $18000 for the MIAB group and 8 days and $27800 for the conventional group (P .05). There were no significant differences in major complications (10% in the MIAB group vs 11% in the conventional group), wound complications (10% vs 11%, respectively), primary assisted patency at 1 year (68±11% vs 78±10%, respectively), secondary patency at 1 year (79±10% vs 88±8%, respectively), limb salvage at 1 year (85±10% vs 94±6%, respectively), or patient survival at 1 year (89±8% vs 61±13%, respectively).
Conclusion Patients undergoing the MIAB procedure avoided lengthy vein exposure incisions without sacrificing short-term results. There was a trend toward decreased hospital stay and cost, which may be further realized as the clinical experience broadens. Although longer follow-up and larger cohorts will always be required to define durability, immediate access to outcomes and costs on small numbers of patients facilitates the early assessment of emerging technology.
From the Department of Surgery, University of Chicago, Chicago, Ill. Dr Rosenthal is now with the Department of Surgery, Medical College of Georgia, and Vascular Surgery, Georgia Baptist Medical Center, Atlanta.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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Arch Surg 1998;133:1156-1159.
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