Endoscopically-Assisted In-Situ Lower Limb Arterial Reconstruction is Safe and Effective: a Retrospective Cohort Study

Objective Compared with the traditional open approach, minimally invasive vascular surgery techniques may offer benefits to patients undergoing lower extremity arterial reconstruction. We sought to determine whether endoscopically-assisted in-situ lower extremity bypass for chronic limb-threatening ischemia is as safe and effective as traditional approaches. Methods From 2021 – 2024, we performed a retrospective cohort study of endoscopically-assisted femoropopliteal or femorotibial bypass on 10 patients in an academic hospital in Ontario, Canada. Patients were selected based on the presence of Rutherford grade four to six ischemia and anatomic suitability for in-situ bypass, age over 18, and ability to tolerate surgery; no patients withdrew from the study but one died of unrelated causes before reaching the one-year mark after surgery. We recorded patient demographics such as medical comorbidities (diabetes, coronary artery disease, etc.). We also documented outcomes (one-year amputation-free survival, major adverse cardiac or limb events, major revascularization, etc.). Follow-up with arterial duplex scanning was performed at one month, three months, and then yearly after surgery; data were collected up to one year after surgery. Results The mean age of patients was 72.4 years, with 70% males. The amputation free survival at 1-year was 80%, The 30-day mortality was 0.0%,while the 1-year mortality was 10.0%, with the only mortality being secondary to a new diagnosis of gastric cancer. At 1-year of follow-up, the primary, primary assisted and secondary patencies were 66.7%, 88.9%, and 100%, respectively. There were no major adverse cardiac events at 30-day or 1-year. There were no post-operative bleeding events requiring intervention, and no residual AV fistula's on surveillance imaging. The median hospitalization length of stay was 4.4 days (1-11). Conclusion Our outcomes suggest that endoscopically-assisted lower extremity bypass for chronic limb threatening ischemia is safe and effective in a select patient population with chronic limb threatening ischemia.