ArticleJournal of vascular surgery cases and innovative techniques2026
Endoscopically-assisted in-situ lower limb arterial reconstruction is safe and effective: A retrospective cohort study.
Article in Journal of vascular surgery cases and innovative techniques, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 to 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 4 to 6 ischemia and anatomic suitability for in-situ bypass, aged over 18 years, and ability to tolerate surgery; no patients withdrew from the study but one died of unrelated causes before reaching the 1-year mark after surgery. We recorded patient demographics such as medical comorbidities (such as diabetes and coronary artery disease). We also documented outcomes (such as 1-year amputation-free survival, major adverse cardiac or limb events, and major revascularization). Follow-up with arterial duplex scanning was performed at 1 and 3 months, and then yearly after surgery; data were collected up to 1 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%, whereas the 1-year mortality was 10.0%, with the only mortality being secondary to a new diagnosis of gastric cancer. At 1-year follow-up, the primary, primary-assisted, and secondary patency rates were 66.7%, 88.9%, and 100%, respectively. There were no major adverse cardiac events at 30-day or 1-year. No postoperative bleeding events requiring intervention or residual arteriovenous fistulas were identified on surveillance imaging. The median hospitalization length of stay was 4.4 days (1-11). Conclusions: 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.
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