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PubMed1997

Internal carotid stent implantation with angioscopic control.

Stent implantation is a method, which is being used more and more often, mainly in the field of peripheral arteries, but coronary stent implantation is also well-known. The authors apply this procedure for patients, who besides the carotid bifurcation stenosis also suffer from the internal carotid stenosis in a longer section of the artery. The indication are as follows: 1 in the case of internal carotid stenosis in a longer section we assure the flow with the help of carotid thrombendarterectomy and slove the run-off with balloon catheter dilatation and stent implantation. 2. in the case of a stenosis in a short section we use stent implantation to avoid dissection of the intima. With each intervention we perform the carotid bifurcation thrombendarterectomy. The authors made the first intervention 15 months ago, since then we have performed 17 stent implantations. One of the 17 patients developed a temporary stroke (TIA). This is a new method, further cases are needed for long-term experiences. Intervention under eye-control can be carried out with more confidence. As regards to the post-operative medicinal treatment, the administration of thrombocyte aggregation-blockers or heparinoid preparation (e.g.: PPS-SP 54) after the stent implantation has become a routine therapy. Summarized the foregoing, these cases constitute about 10-15% of all carotid operations, therefore the authors would like to make it clear, that this is not a routine method, but a possibility, strictly respecting the above-mentioned indications.

Aortic Dissection↗
PubMed1993

Saphenous vein angioscopy: a valuable method to detect unsuspected venous disease.

PURPOSE: The presence of preexisting saphenous vein lesions adversely affects graft patency. Despite careful preoperative venous duplex examination and meticulous intraoperative evaluation, clinically significant saphenous vein disease may remain undetected. We evaluated angioscopy as a means to better detect these vein lesions. METHODS: Ninety saphenous vein remnants, obtained at bypass surgery, were perfusion fixed for subsequent angioscopic and histologic evaluation. The specimens were categorized by independent examiners on the basis of the angioscopic or light microscopic findings. Of the 90 vein remnants, 66 were normal by angioscopic criteria. Fifty-three (80%) of these angioscopically normal vein segments were normal histologically, and all 24 angioscopically abnormal saphenous vein remnants showed disease on microscopic examination. RESULTS: Angioscopy correctly identified sclerotic vein segments (n = 20) by irregular white plaques, whereas postphlebitic veins (n = 3) demonstrated multiple lumens, fibrous strands, and thickened opaque valve cusps on angioscopic evaluation. Absence of an angioscopic lumen was confirmed histologically in occluded veins (n = 2). Angioscopy failed to identify thick-walled (n = 10) and varicose (n = 2) vein segments as abnormal; one sclerotic segment was normal angioscopically, thereby lowering the sensitivity of angioscopy. CONCLUSIONS: Angioscopy detected unsuspected preexisting saphenous vein disease in five patients undergoing arterial reconstruction with saphenous vein. Because the use of angioscopy is a reliable means of prospectively assessing the vein for most preexisting lesions, its routine use may ultimately improve graft patency.

Angioscopy↗
PubMed1995

Intraoperative angioscopy for coronary bypass surgery.

Despite advances in coronary artery surgery, technical abnormalities remain a significant cause of early graft closure. The development of small fiberoptic angioscopes now allows direct intravascular magnified examination. Seventy-five distal anastomoses and vein grafts, and five selected coronary arteries were examined with 0.8- to 2.5-mm diameter angioscopes introduced through the proximal vein graft while irrigating with clear cardioplegia. Angioscopic findings were correlated with angiographic data, vessel morphology, graft flow, and postoperative course. Satisfactory images were obtained in 72 of 75 anastomotic inspections. Each examination took less than 2 minutes and required less than 100 cc of flush. Angioscopic abnormalities that did not require revision were noted in 17 of 72 anastomoses; intimal flaps in 9, thrombus on posterior wall plaque in 4, intimal irregularities in 4, bucking of posterior wall in 3, and valve near anastomoses in 1. No outflow obstruction nor misplaced sutures were noted. Average flow rate through the grafts with anastomotic angioscopic abnormalities was 33 cc/min versus 40 cc/min in the remaining grafts. However, regression analysis revealed that low-graft flow was correlated with vessel size and runoff but was not with angioscopic findings. Intracoronary angioscopy revealed discrepancy with angiographic findings in 4 of the 5 examinations. No complications occurred as a result of angioscopy. No graft closure has occurred during early follow-up. Intraoperative angioscopy can be done with minimal alteration of the usual routine. The 24% occurrence of minor angioscopic abnormalities did not appear to compromise graft flow or early patency.

Angioscopy↗
PubMed1995

Prospective study of the value of prebypass saphenous vein angioscopy.

BACKGROUND: The patency of a saphenous vein graft is directly related to the quality of the vein harvested. Thus, appropriate evaluation of the vein before implanting it as a bypass graft may help identify those veins at high risk for early failure. Accordingly, we prospectively investigated whether prebypass angioscopic assessment of the saphenous vein could identify those vein grafts at particularly high risk of early failure. PATIENTS AND METHODS: Thirty-two greater saphenous veins with a grossly normal appearance were evaluated angioscopically before their use as a bypass conduit. After modification of abnormal segments, all of the veins irrigated well and were used as bypass grafts. RESULTS: Twenty-four patients were available for follow-up at 12 months. Seventeen (71%) had been prospectively classified as having angioscopically normal saphenous veins, while 7 were identified as having abnormal veins. The two groups did not differ significantly in demographics, cardiovascular risk factors, or indications for operative intervention. Twelve of the 17 (70%) normal veins were patent at 1 year; however, only 1 (14%) of the angioscopically abnormal vein grafts remained patent for 12 months (chi-square = 4.27; P = 0.039). CONCLUSION: Angioscopic inspection of the saphenous vein, before insertion as a graft, allows for identification of unrecognized venous disease that portends early graft thrombosis. Exclusion of abnormal veins, based on an abnormal angioscopic appearance, may lead to improved results for lower-extremity revascularization procedures; this supports the value of vein-graft angioscopy.

Angioscopy↗
PubMed1994

Intraoperative control following femorodistal revascularization: angioscopy is superior to angiography.

Intraoperative angioscopic control was performed in an early series of 27 patients undergoing peripheral vascular surgery. The majority were complex or re-do operations; reversed saphenous vein and PTFE-grafts were used as bypass material exclusively. Angioscopic findings were compared to conventional angiography with respect to the detection of technical problems leading to further surgical procedures. Angioscopy was feasable in 92.5%, it failed twice due to irrigation problems, which was before we used a dedicated angioscopy roller-pump. In 6 patients relevant findings requiring further surgical manipulations were only detected angioscopically, in 2 patients such findings were detected by angioscopy as well as by angiography. Such findings included technical problems (graft rotation [n = 1], anastomotic narrowing [n = 2]), balloon catheter injuries after thromboembolectomy (n = 2) and residual thrombi after local thrombectomy (n = 3); 5 of these patients had undergone previous vascular procedures in the same operation field. After local correction (n = 5) or placement of a new bypass (n = 3) there was no early graft failure. This early angioscopic experience confirmed previous reports that satisfactory visualization and specific recognition of angiographically unsuspected problems after peripheral reconstructions can be obtained by intraoperative angioscopic control. This was seen very distinctively in more complex and re-do operations, which we see as the cases most needing routine angioscopic control.

Aged↗
PubMed2000

[Coronary angioscopy in ischemic heart disease].

The validity of coronary angioscope was discussed in several clinical settings in this article. First of all, although smooth coronary surface was observed by coronary angiography after the intervention of chronic total occlusion, protrusion or thrombus observed by angioscope occupied the arterial lumen and closed the vessel lumen. After implantation of the stent, lumen was widely opened. Serial angioscopic observation revealed that the neointima became thick and non-transparent until 6 months and then became thin and transparent by 3 years after stent implantation. These findings suggested the validity of angioscope in coronary intervention. Second, coronary angioscope revealed the morphologic and pathologic characteristics of culprit lesions in patients with acute coronary syndrome. The thrombus was observed on the yellow plaque in the culprit lesion. The thrombus formed directly over the plaque was mainly white and red thrombus might be formed after the blood flow was disturbed by the white thrombus formed by the platelet aggregation. These findings imply the importance of anti-platelet therapy after acute coronary syndromes. Finally, the angioscope can detect the minimal changes of the plaque formation, progression and rupture, that is, the entire process of the atherosclerosis. The early detection of yellow plaque might be able to intervent mechanically or pharmacologically to prevent its rupture.

Angioscopy↗
PubMed1996

Coronary thrombi increase PTCA risk. Angioscopy as a clinical tool.

BACKGROUND: The presence of angiographically identified intracoronary thrombus has been variably associated with complications after coronary angioplasty. Angiography has been shown to be less sensitive than angioscopy for detecting subtle details of intracoronary morphology, such as intracoronary thrombi. The clinical importance of thrombi detectable by angioscopy but not by angiography is not known. METHODS AND RESULTS: Percutaneous coronary angioscopy was performed in 122 patients undergoing conventional coronary balloon angioplasty (PTCA) at six medical centers. Unstable angina was present in 95 patients (78%) and stable angina in 27 (22%). Therapy was not guided by angioscopic findings, and no patient received thrombolytic therapy as an adjunct to angioplasty. Coronary thrombi were identified in 74 target lesions (61%) by angioscopy versus only 24 (20%) by angiography. A major in-hospital complication (death, myocardial infarction, or emergency bypass surgery) occurred in 10 of 74 patients (14%) with angioscopic intracoronary thrombus, compared with only 1 of 48 patients (2%) without thrombi (P = .03). In-hospital recurrent ischemia (recurrent angina, repeat PTCA, or abrupt occlusion) occurred in 19 of 74 patients (26%) with angioscopic intracoronary thrombi versus only 5 of 48 (10%) without thrombi (P = .03). Relative risk analysis demonstrated that angioscopic thrombus was strongly associated with adverse outcomes (either a major complication or a recurrent ischemic event) after PTCA (relative risk, 3.11; 95% CI, 1.28 to 7.60; P = .01) and that angiographic thrombi were not associated with these complications (relative risk, 0.85; 95% CI, 0.36 to 2.00; P = .91). CONCLUSIONS: The presence of intracoronary thrombus associated with coronary stenoses is significantly underestimated by angiography. Angioscopic intracoronary thrombi, the majority of which were not detected by angiography, are associated with an increased incidence of adverse outcomes after coronary angioplasty.

Adult↗
PubMed1988

Intraoperative decisions based on angioscopy in peripheral vascular surgery.

We describe the technique of intraoperative angioscopy for delineation of peripheral vascular anatomy. Angioscopes with outer diameters of 0.85-2.9 mm have been used during 86 peripheral vascular procedures. Angioscopic inspections were performed during 68 femoral popliteal bypasses, four aortofemoral bypass grafts, one abdominal aortic aneurysm, two extra anatomic axillary femoral bypass grafts, and 11 other vascular procedures. We obtained useful images in 73 of 86 procedures (85%), thereby yielding 118 angioscopic inspections (53 arteries, 37 anastomoses, and 28 vein grafts). Changes in intraoperative management based on angioscopic findings included revision of five of 37 (14%) anastomoses, deletion of four of 31 (13%) completion angiograms, revision of eight of 17 (47%) in situ venous valves, and repetition of thrombectomy in six of seven (86%) cases. In 22 of 73 (30%) peripheral angioscopies, potential causes of graft occlusion were recognized. Complications from intraoperative angioscopy have included one anastomotic flap from intimal disruption that required anastomotic revision. Three small flaps, possibly resulting from angioscopic trauma, were recognized but appeared to have no clinical significance. In conclusion, intraoperative angioscopy provides visual assessment of luminal patency and anastomotic anatomy. This assessment alters intraoperative procedures in some cases and cannot be obtained by angiography.

Adult↗
PubMed1994

Role of angioscopy in reoperation for the failing or failed infrainguinal vein bypass graft.

The purpose of this retrospective study is to review our ongoing experience with the use of angioscopy during reoperation for failed or failing infrainguinal vein bypass grafts and define the role of angioscopy in the management of this clinically demanding patient group. All hospital records, arteriograms, and intraoperative angioscopic video recordings of 79 consecutive failed or failing grafts (76 patients) examined with angioscopy during reoperation between 1987 and 1993 were reviewed. Clinical and intraoperative data, comparison of the preoperative arteriogram and intraoperative angioscopic findings, and surgical decisions or interventions resulting from the additional angioscopic findings were collated and analyzed according to a predetermined protocol. Sixty-six additional angioscopic findings were noted during the 79 reoperations and resulted in 61 additional interventions and surgical decisions with salvage of all or part of the graft in 90.9% in the early (< 30 day) failed (group 1), 84.6% in the late (> 30 day) failed (group 2), and 90.3% in the late (> 30 day) failing grafts (group 3). The amount of residual thrombus within the graft, as assessed by angioscopy after all interventions, was the critical determinant for overall early graft patency (p < 0.001) and long-term patency for all the subgroups after reoperation (group 1, p < 0.001; group 2, p = 0.0016; and group 3, p = 0.0194). Intraoperative angioscopy has an important role in these challenging procedures. It provides additional and useful information that not only influences the conduct and extent of the reoperative surgery but may provide insights into the pathogenesis of graft failure.

Adult↗
PubMed1994

Neointimal coverage of stents in human coronary arteries observed by angioscopy.

OBJECTIVES: The aim of this study was to reveal the time course of the neointimal coverage of stents placed in the human coronary arteries. BACKGROUND: In deciding the protocol of anticoagulant and antiplatelet therapy for patients who undergo stent implantation, the condition of the neointimal coverage of stents should be taken into consideration. However, the time course of the neointimal coverage of stents has not been elucidated in human coronary arteries. METHODS: Serial angioscopic observations were performed immediately after stenting, at 8 to 45 days (short-term follow-up) and at 65 to 142 days (long-term follow-up) in patients who underwent implantation of the Wiktor coronary stent in the restenotic lesion or in the lesion of acute or threatened closure after balloon angioplasty. RESULTS: Angioscopic observations were successfully performed in 14 cases immediately after stenting, in 11 cases at short-term follow-up and in 13 cases at long-term follow-up. Immediately after stenting and even at 8 to 18 days after stenting, the stent was not covered by the neointimal layer in any case. However, at 65 to 142 days after stenting, the stent was covered by the neointimal layer in all cases. Angioscopically, three types of neointimal layer were recognized: a white layer with a cottonlike surface in three cases, a white layer with a smooth surface in eight cases and a transparent layer with a smooth surface in two cases. CONCLUSIONS: Although some experimental results in animals have shown completion of neointimal coverage of stents in a few weeks, in this serial angioscopic follow-up study, the completion of neointimal coverage of stents in human coronary arteries required approximately 3 months.

Angioscopy↗
PubMed1997

Heterogeneity of cardiac allograft vasculopathy: clinical insights from coronary angioscopy.

OBJECTIVES: With this study, we sought to examine the heterogeneity of cardiac allograft vasculopathy in vivo using coronary angioscopy as an adjunct to intravascular ultrasound, and we evaluated the clinical relations of immunologic and nonimmunologic risk factors with the different forms of cardiac allograft vasculopathy detected angioscopically. BACKGROUND: Intravascular ultrasound detects vascular intimal proliferation accurately but is limited in its ability to delineate morphologic characteristics. Coronary angioscopy can evaluate intimal surface morphology by direct visualization and can differentiate pathologically distinct forms of plaque topography on the basis of color and contour. METHODS: We studied 107 consecutive heart transplant recipients with intravascular ultrasound and angioscopy at the time of their annual angiogram, and we assessed the relation of nonimmunologic and immunologic risk factors to the development of cardiac allograft vasculopathy distinguished angioscopically into a pigmented (yellow) or nonpigmented (white) intimal thickening. We further evaluated the clinical differences in cardiac events among these two forms of angioscopically heterogeneous forms of cardiac allograft vasculopathy. RESULTS: Significant clinical predictors of nonpigmented intimal thickening were advanced donor age and lower mean cyclosporine levels, whereas hyperlipidemia, cumulative prednisone dose and time since transplantation correlated with pigmented intimal hyperplasia. In addition, comparisons between the two angioscopic groups revealed increased intimal thickening, serum cholesterol, low density lipoprotein cholesterol, acute allograft rejection and time since transplantation in the group with pigmented intimal thickening (p < 0.05). With regard to cardiac events, nonpigmented plaque was more frequently found in the sudden death group (53% vs. 20%, p = 0.05), whereas the nonsudden cardiac event group had a significantly higher prevalence of pigmented plaque (80% vs. 47%, p = 0.07). CONCLUSIONS: These findings indicate that cardiac allograft vasculopathy is a heterogeneous disease with varied morphologic expressions with different clinical implications. Furthermore, this investigation provides insight into the cohesive, yet diverse influences of various factors, particularly immunosuppression, in these forms of cardiac allograft vasculopathy.

Adult↗
PubMed1995

Quantitative endoluminal measurements during angioscopy: an innovative technique.

AIM: To evaluate angioscopy in this Unit with respect to its application in lower limb vascular reconstructions. By providing magnified, colour images of the luminal surfaces of vein grafts, anastomoses and native arteries, angioscopy allows direct visualisation of imperfections and is sensitive in diagnosing technical problems. However, assessment is qualitative and magnification of the image can distort the operator's impression of true size. Angioscopy would be more versatile if it were possible to quantify the observed images. METHOD: A new technique has been developed to measure intra-luminal diameter from the angioscopic images. A linear displacement transducer is attached to the angioscope and accurately monitors its axial shift. Signals from the transducer are received by a personal computer equipped with a video frame grabber and analogue digital converter, together with appropriate software. The computer generates calculated dimensions based on geometrical principles, once each angioscope has been appropriately calibrated at the outset. RESULTS: Laboratory studies examining tubes of known dimensions have confirmed the reproducibility and accuracy of the technique. Simultaneous angioscopic and Duplex ultrasound measurements of the internal diameters of segments of vein suspended in a water bath were then carried out. Using the Duplex results as the 'gold standard', there was a strong correlation between the measurements obtained with the two techniques (Rs = 0.92). CONCLUSIONS: In the clinical context, this system has the capability to generate accurate endoluminal measurements during angioscopy. This has application for quality control in the selection of veins and inspection of run-off vessels during bypass grafting and in completion studies, following both operative and percutaneous procedures.

Analog-Digital Conversion↗
PubMed1996

Angioscopy for quality control of saphenous vein during bypass grafting.

OBJECTIVES: Although autogenous vein is the conduit of choice for infrainguinal bypass grafting, some 20-30% of vein grafts fail during the first year postoperatively. Many of these failed veins are now known to have pre-existing pathological changes. Angioscopy enables intraoperative endoluminal visualisation of veins and can reveal anomalies, some previously unsuspected, despite preoperative Duplex ultrasound mapping and normal external appearances. The aim of this study was to compare angioscopic findings with contemporary histological appearances and with subsequent graft outcome and ultimately, to identify those endoluminal features which might be predictive for failure. METHODS: Angioscopic vein inspection was carried out using Olympus 1.4 and 2.2mm angioscopes in patients undergoing femoropopliteal/distal bypass. Severe disease in the veins of five patients led to preferential use of polytetrafluoroethylene (PTFE) for above-knee bypasses. The remaining 38 videotaped sequences were reviewed by two surgeons and scored using a scale of 0 to 3, based on frequency and distribution of angioscopically detected lesions. These included haemorrhagic mural plaques, flimsy intraluminal strands, webs/bands and mobile/adherent thrombus. Vein harvested at operation was assessed by a pathologist according to the level of pre-existing abnormality. RESULTS: There were significant associations between angioscopy/histology scores and graft survival (chi 2 = 22.00; df:3; p < 0.001; chi 2 = 22.43; df:3; p < 0.001 respectively). There was a significant correlation between angioscopy and histology scores (R8 = 0.725; p < 0.001). CONCLUSIONS: Angioscopy allows immediate identification of the at risk, poor quality vein graft at the time of surgery, without the delays inherent with histological preparation and assessment. Recognition of abnormalities at angioscopy may ultimately improve graft outcome by prospectively eliminating use of poor vein.

Adult↗
PubMed1993

An alternative method of salvaging occluded suprainguinal bypass grafts with operative angioscopy and endovascular intervention.

PURPOSE: A study of technical feasibility was undertaken to determine whether angioscopy and parallel endovascular instrumentation could effectively evaluate and restore inflow into occluded suprainguinal grafts. METHODS: Several endobronchial instruments were selected for adaptation for use in clearing occluded grafts under angioscopic guidance. These instruments were used in the treatment of 12 thrombosed grafts limbs in 10 patients who were admitted 1 to 40 days after occlusion. The occluded suprainguinal graft limbs were exposed just proximal to the femoral anastomosis. Blind retrograde balloon thrombectomy and clot extraction were performed. Graft limbs underwent angioscopy, and the presence of luminal defects were recorded. Endoluminal instruments were then inserted parallel to the angioscope, and luminal defects were corrected. After inflow was reestablished, the distal portion of the graft was thrombectomized, and any necessary distal revisions were performed. RESULTS: Blind retrograde thrombectomy was successful in restoring inflow deemed normal in (67%) eight of 12 graft limbs and present but diminished in two (17%) graft limbs. Balloon thrombectomy was ineffective in restoring graft flow in two (17%) graft limbs. Angioscopy revealed luminal defects in 10 (83%) graft limbs after blind retrograde thrombectomy. Only 2 (17%) graft limbs had no luminal defects after thrombectomy. Findings included pseudointimal flap in eight of 12 (67%), adherent residual thrombus in 4 (33%), and kinked graft limbs in 2 (17%) graft limbs. Endovascular instrumentation was successful in resecting all luminal disease under angioscopic guidance. There were no deaths, no episodes of graft injury or distal embolization, and only one groin hematoma. During a mean follow-up period of 6 months (2 to 13 months), there was one late reocclusion at 7 months. CONCLUSION: We conclude that angioscopically guided thrombectomy and endovascular graft revision is a useful approach to the treatment of the occluded suprainguinal graft. Enhanced luminal visualization permits refined diagnostic assessment and definitive therapy. This may prolong the benefit of suprainguinal reconstructions.

Aged↗
PubMed1985

Delineation of peripheral and coronary detail by intraoperative angioscopy.

In this study, the development of intraoperative angioscopy, the value of the information obtained, and the problems encountered with the procedure are reported. Eight angioscopes, 1.5 to 2.8 mm in diameter, with a line resolution of greater than 0.4 mm at 5 mm, were used. One-hundred ten angioscopic investigations were performed in 46 patients; 24 at peripheral bypass surgery and 22 at coronary artery bypass surgery. These included 68 arteries, 28 new anastomoses, six old grafts, five laser angioplasties, and three in situ vein grafts. The most important finding was that angioscopic data provide information not available from probes or angiography. Angioscopic findings were responsible for a change in surgical procedures in 12 patients (26%) including three anastomotic revisions, three alterations in graft site placement, and two repeat thrombectomies. The most significant technical problems were lack of steerability and insufficient irrigation, which resulted in poor angiographic images. Further technical development is necessary before routine intraoperative angioscopy is practical. Nevertheless, if these problems are resolved, angioscopy will provide unique, high-resolution information which can directly alter surgical therapy.

Angioplasty, Balloon↗
PubMedDate not supplied

Direct observation of the portal vein interior by intra-operative angioscopy in the dog and man.

The purpose of this study was to develop the technique of intra-operative portal angioscopy using a portal angioscope, and to demonstrate its potential use in the therapy for patients with hepatocellular carcinoma (HCC) bearing a portal thrombus. Portal angioscopes, Olympus BF3C10 and CHFP10 of a diameter of 3.5 mm and 4.8 mm, respectively, were used during operation in five dogs, two patients with hepatic metastasis from colon cancer and three patients with HCC having a portal tumour thrombus. The portal vein and hepatic artery were ligated simultaneously, and the angioscope was immediately introduced under direct vision through a small portal venotomy. Blood in the portal vein was almost fully diverted by infusion of heparinized saline through a channel of the angioscope at a rate of 3 mL/min in dogs and 5 mL/min in patients with hepatic metastasis. Rates of 6 mL/min and 10 mL/min in dogs and patients, respectively, were adequate to clear completely the portal vein of blood. In patients with HCC, portal tumour thrombectomy was performed with a Fogarty balloon catheter by suctioning thrombi through a channel of the fibrescope after visual study of the portal thrombus. Observation and treatment of portal thrombus by angioscopy may become an important part of surgical treatment of HCC with portal invasion, but further technical improvement is desirable before this technique becomes a routine procedure.

Animals↗
PubMed1992

Angioscopy-guided semiclosed technique for in situ bypass with a novel flushing valvulotome: early results.

To allow and facilitate endoluminal vein preparation under angioscopic guidance for in situ bypass grafting, a Mill's valvulotome was equipped with a flushing channel. The advantages of the novel valvulotome are obvious: it allows perfect angioscopic view within a saphenous vein that still contained blood by adjusting the jet of lactated Ringer's solution directly to the lens of the angioscope; it permits the use of very small angioscopes without integrated flushing channels, preventing endothelial damage. The described technique was tested in 27 peripheral reconstructions in 26 patients. The secondary cumulative patency rate within a follow-up time of 4 to 30 months (mean, 14 months) was 89%. The described technique substantially facilitates in situ bypass grafting and minimizes early and late complications and further improves surgical outcome.

Aged↗
PubMed1993

Intraoperative angioscopy after carotid endarterectomy.

The angioscopic evaluation of the carotid bifurcation has proved valuable for intraoperative quality control after carotid endarterectomy (CEA). From January 1989 to July 1990, intraoperative angioscopy was performed in 196 patients undergoing CEA. We used a 2.2, 2.8 or 3.6 mm angioscope inserted at the end of the CEA through the remaining opening in the suture line. The angioscopic findings were classified as follows: I--no pathology (68%), II--thrombi, smaller debris, suture irregularities (29%), III--intima flap, endoscopic removal (3%), IV--intima flap, surgical redo (3%). Our results support the practicability and importance of intraoperative angioscopy for surgical decision making. It is possible to rinse out thrombi or remove remaining debris using flexible forcepy, under direct visual control. There were no significant complications related to the angioscopic procedure.

Aged↗