A narrative review of the role of endoscopically assisted in situ bypass in the modern era of limb salvage vascular bypass

Objective

In this narrative review, we seek to summarize key literature describing nontraditional minimally invasive in situ lower extremity bypass techniques. We describe the various historical and newer attempts and their known outcomes to date. We particularly focused on the sparsely used endoscopic-assisted in situ bypass technique.

Methods

A list of search terms and keywords relevant to novel in situ bypass techniques was identified. A retrospective review of the literature was conducted screening PubMed/MEDLINE and Scopus with a search period from January 1, 1959, to August 1, 2023.

Results

Our search yielded six previous studies that used various permutations of the novel in situ bypass techniques. Despite the relative paucity of high-quality data, the studies demonstrate that the endoscopic technique results in lower wound complications rates, shorter hospital stays, and no significant differences in outcomes compared with the traditional in situ bypass technique.

Conclusions

The endoscopic in situ bypass technique demonstrates important wound-related benefits compared with the traditional in situ technique. This minimally invasive approach is certainly in keeping with the current technical knowledge and skillset in vascular surgery. Future studies are needed to systematically compare the long-term outcomes.