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At least 415 records · Page 23Linked to original sources
PubMed1994

Effect of balloon inflation in angiographically normal coronary segments during coronary angioscopy: a quantitative angiographic study.

Visualization of coronary stenoses by coronary angioscopy is facilitated by inflating an occlusive cuff located near the distal end of the device to temporarily interrupt blood flow. In animal models, this procedure induces substantial endothelial denudation. Experimental studies show that endothelial denudation may lead to neointimal hyperplasia at the denuded site. This study was designed to determine whether angioscopy was associated with significant changes in lumen diameter at the site of cuff inflation. We studied 52 consecutive patients undergoing coronary angioscopy. We measured with use of quantitative edge-detection angiography [computer-assisted evaluation of stenosis and restenosis (CAESAR) system] the mean and minimal lumen diameters at the site of cuff inflation localized by filming the inflated cuff during angioscopy and at control non-instrumented segments on angiograms performed before angioscopy, after angioscopy, and at 6 months follow-up. Follow-up angiograms were performed in 80% of eligible patients. At follow-up, the mean (3.22 +/- 0.54 mm) and minimal (2.76 +/- 0.58 mm) diameters of the segment exposed to the inflated cuff were not significantly different from the equivalent values (3.22 +/- 0.58 and 2.75 +/- 0.61 mm) before angioscopy. No significant changes occurred in the mean or minimal diameters of the control segments over the same period. The late change (follow-up minus pre-angioscopy) in mean lumen diameter at the cuff inflation site (-0.005 +/- 0.18 mm) was not significantly different from that at the control site (0.004 +/- 0.20 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Angioscopy in vascular surgery: the state of the art.

Although angioscopy is considered by many vascular surgeons to be a valuable clinical tool, others view it as expensive and unnecessary. To better define the appropriate role for angioscopy in vascular surgery, a critical review of the recent literature was undertaken. Angioscopy allows more complete valvulotomies with fewer endothelial injuries when preparing autogenous veins to be used as arterial conduits, and results in more complete thromboembolectomy of native arteries and grafts. Angioscopy can replace completion arteriography in infrainguinal arterial reconstructions with an equivalent clinical outcome. Angioscopy may be useful in the assessment of carotid endarterectomy, femoral vein valve repair, and pulmonary embolectomy. It has been useful in various research applications. The rate of complications is less than 1%. Angioscopy is of benefit in preparing veins to be used as arterial conduits and in performing thromboembolectomy. In some circumstances it can replace intraoperative arteriography. Other applications await further validation. The risks of angioscopy are acceptably low.

Angiography↗
PubMed2004

Totally endoscopic coronary artery bypass graft: initial experience with an additional instrument arm and an advanced camera system.

BACKGROUND: Robotically enhanced telemanipulation for totally endoscopic coronary artery bypass does not provide adequate tactile feedback, traction, or countertraction. The exposition of coronary target sites is difficult, the visual field is limited, and the epicardial stabilization may be troublesome. A fourth robotic arm for endothoracic instrumentation has been added to the da Vinci surgical system to facilitate totally endoscopic operations. The stereoendoscope was upgraded with a wide-angle feature. METHODS: The procedure was performed in five patients. Four of these patients had left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting on the beating heart and the fifth had sequential bypass grafting (LITA to diagonal branch and LAD) on an arrested heart. The additional effector arm of the da Vinci surgical system was brought into the operative field beneath the operating table and used as a second right arm. The wide-angle view was activated by either the console or the patient side surgeon. RESULTS: The mean operative, port placement, and anastomotic times for a beating-heart totally endoscopic coronary artery bypass were 195 +/- 58, 25 +/- 10, and 18 +/- 5 min, respectively. All procedures were free of morbidity and mortality, with satisfactory angiographic control. The sequential arterial bypass grafting procedure was fully completed in totally endoscopic technique. CONCLUSIONS: The additional instrumentation arm and wide-angle visualization are useful technical improvements of the da Vinci surgical system, solving the problem of traction, countertraction, and facilitated exposition of target sites as well as visualization of the surgical field. They provide potential for wider acceptance of totally endoscopic coronary artery bypass grafting in a larger surgical community.

Aged↗
PubMed1995

Aortofemoral graft occlusion: strategy and timing of reoperation.

The authors' experience with 46 patients treated over 8.5 years was reviewed to determine the optimal secondary revascularization procedure after occlusion of a unilateral aortobifemoral graft limb. A total of 64 procedures was performed on these patients to restore and maintain graft patency. Repetitive operations for reocclusion were needed in 14 patients (30%). Transcatheter thrombolytic therapy was used in 14 patients, four as sole therapy and 10 in conjunction with operation. The mean time from aortofemoral grafting to presentation with graft limb occlusion was 59.4 months. Rest pain or severe ischemia was present in 85%, and severe claudication in the remainder. Some 78% had urgent operation after diagnostic angiography and catheter-directed thrombolytic therapy was attempted in 22%. The etiology of graft thrombosis was outflow obstruction in 78.2% of cases. Inflow was obtained by surgical thrombectomy in 35 and by lytic therapy in 13. Extra-anatomic inflow was used in 11 and intra-abdominal thrombectomy or redo aortofemoral grafting in five. Outflow procedures, mainly profundaplasty, were performed in all but five cases (four urokinase and one surgical). Infrainguinal bypass was needed in 10 cases in addition to the groin reconstruction. Catheter-directed thrombolysis was successful in 13 of 14 instances; however, in nine of these residual stenosis was disclosed in the outflow requiring surgical repair. Ultimately, 12 of 14 cases treated with thrombolysis required surgical intervention. Cumulative patency for all procedures was 68%. Complications were seen in 14% of cases. Operative mortality was 5%, and limb salvage was obtained in 85%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Totally endoscopic robotic-guided pulmonary veins ablation: an alternative method for the treatment of atrial fibrillation.

In patients affected by isolated atrial fibrillation, epicardial pulmonary veins ablation can be performed with minimally invasive robotic-guided cardiac surgery techniques. This approach might become a feasible alternative to percutaneous transcatheter procedures. In this case report, we present a totally endoscopic robotic-guided pulmonary veins microwave ablation, on beating heart. A 64-year old male patient affected by paroxysmal atrial fibrillation was scheduled for an epicardial ablation procedure. Through three 1 cm-length port accesses, the "da Vinci" robotic system's camera and arms were introduced in the patient's chest. The pericardial reflections along the superior and inferior vena cava, as well as the transverse sinus, were dissected. Through an additional 0.5 cm-length port, a guidewire was advanced gradually across the transverse sinus, the diaphragmatic surface of the heart and the oblique sinus, finally surfacing outside the thoracic wall through the same port. Once tied to the microwave probe, the guidewire was pulled out carrying the probe inside the chest up to encircle the pulmonary veins. Once in place, a box lesion of the pulmonary veins was produced by microwave. At the 3-month follow up the patient is in sinus rhythm and so far did not longer experienced paroxysmal arrhythmic episodes.

Angioscopes↗
PubMed2006

Early human experience with use of a deflectable fiberoptic endocardial visualization catheter to facilitate coronary sinus cannulation.

BACKGROUND: Despite improvements in cardiac resynchronization therapy (CRT) implantation techniques, a significant minority of CRT attempts are unsuccessful. Inability to cannulate the coronary sinus (CS) because of difficult anatomy is a major reason for unsuccessful CRT implantation. Direct visualization of intracardiac structures during the implant may facilitate access into the CS. The present study describes CRT implantation with the aid of an endocardial visualization catheter (EVC). METHODS: Fifty-eight consecutive patients (mean age 72 +/- 12 years; ejection fraction 26.2% +/- 7.0%; New York Heart Association [NYHA] class 2.9) underwent CRT implantation using a steerable fiberoptic EVC (Acumen Medical, Inc., Sunnyvale, CA). RESULTS: The EVC was able to visualize the CS ostium in all cases. The CS was successfully cannulated in 57 (98.3%) of 58 patients. The time from vascular access to CS visualization was 6 +/- 5 minutes, and the total time to CS access was 8 +/- 6 minutes. Successful left ventricle (LV) lead implantation was accomplished in 55 (94.8%) of 58 patients. Three patients who had a previous history of failed LV lead implantation were successfully implanted using the EVC. CONCLUSION: Fiberoptic imaging of intracardiac structures during CRT implantation may be performed rapidly in a wide range of patients with an EVC. The ability to visualize right atrial anatomy may aid CS access and LV lead implantation.

Aged↗
PubMed1998

Endoscopic placement of stents in aneurysms of the descending thoracic aorta.

This is a case of a patient with two saccular aneurysms in the descending aorta. Two self-expanding stents were inserted through an opening in the aortic arch, guided by the use of an Olympus endoscope, under profound hypothermia and total circulatory arrest. The bloodless field made possible the identification of the main thoracic branches, facilitating the positioning and deployment of both stents. Immediate postoperative recovery was excellent.

Aged↗
PubMed1994

Early results of endovascular-assisted in situ saphenous vein bypass grafting.

PURPOSE: This study evaluated an endovascular technique for occlusion of arteriovenous fistula when performing saphenous vein in situ bypass grafting. METHODS: In 31 limbs femoropopliteal (17) or femorotibial (14) in situ bypass grafting was performed for claudication/aneurysm (4), rest pain (6), or tissue loss (21). A valvulotome was used for valve lysis. Saphenous vein branches were identified with angioscopy in 16 limbs or with fluoroscopy in the remainder. An electronically steerable endovascular catheter was used to deliver platinum coils into the venous tributaries to occlude them. RESULTS: The maximal number of coils placed in any limb was nine. Most operations were performed with only a groin incision (length = 9.8 +/- 1.6 cm) and a distal incision (length = 16.8 +/- 6.5 cm). Wound complications occurred in four limbs, whereas four limbs developed localized superficial thrombophlebitis. The postoperative ankle-brachial index increased to a mean of 0.91 +/- 0.12. Postoperative duplex imaging revealed a missed arteriovenous fistula in 12 limbs. Two were surgically ligated, whereas the remainder were embolized in the radiology suite. Postoperative length of hospitalization was 4 +/- 2 days in uncomplicated cases. Follow-up revealed five graft occlusions. Occlusion occurred at 12 hours, 2 weeks, and 6, 14, and 15 months after operation. Although there were no perioperative deaths, two patients have died of unrelated causes. CONCLUSION: This endovascular technique of arteriovenous fistula embolization decreased the length of the surgical wounds, and patients were discharged 4 +/- 2 days in uncomplicated cases. The ultimate test of its efficacy, however, will be long-term functional results.

Adult↗
PubMed1996

Aortoscopy: a guidance system for endoluminal aortic surgery.

PURPOSE: The aim of this project was to evaluate the feasibility of aortoscopy for guidance of endoluminal aortic procedures and to determine whether aortoscopy has advantages over fluoroscopy in a pig model. METHODS: To establish feasibility aortoscopic guidance was used for making endoluminal aortic measurements, cannulating small arteries for arteriograpy, and placing intraaortic stents and grafts in 11 pigs. To compare aortoscopy and fluoroscopy measurements were made and stents were placed by a surgeon using only aortoscopic guidance in 10 pigs and by an interventional radiologist using only fluoroscopic guidance in 10 pigs. Postmortem dissections were performed to determine measurement and device placement accuracy. RESULTS: In the feasibility study aortoscopic measurements differed from postmortem measurements by a mean distance (+/- SD) of 1.2 +/- 0.2 mm. Stents and grafts were placed a mean of 2.3 +/- 1.9 mm distal to the most inferior renal artery with no stent covering an orifice. All attempts at cannulating spinal arteries greater than 2 mm in diameter were successful. In the comparison of aortoscopic and fluoroscopic guidance, fluoroscopic measurements differed from postmortem measurements by 2.6 +/- 2.4 mm (p = 0.223). Stents placed with aortoscopic guidance were 1.1 +/- 1.3 mm distal to the most inferior renal artery, whereas stents placed with fluoroscopic guidance were 3.4 +/- 2.5 mm distal to the most inferior renal artery (p = 0.019). CONCLUSIONS: These results demonstrate that aortoscopy is a useful guidance system for endoluminal aortic procedures and may have advantages over fluoroscopy alone.

Angioscopes↗
PubMed1997

Angioscopy in vascular surgery.

The role of intraoperative angioscopy continues to evolve. To better define the role of angioscopy in vascular surgery, a review of the recent literature was performed. The most well-established indication for angioscopy is preparation of the saphenous vein for in situ bypass; however, angioscopy has also been demonstrated to be useful in the assessment of carotid endarterectomy, femoral vein valve repair, thromboembolectomy, and may be beneficial during endovascular stent grafting. Angioscopy is now a valuable adjunct in the management of the patient with peripheral vascular disease.

Angioscopes↗
PubMed1999

Endoscopic vein harvest techniques for coronary and infrainguinal bypass.

Endoscopic saphenous vein harvest represents a minimally invasive approach to obtain a suitable bypass conduit for coronary or extremity revascularization. Endoscopic vein harvest has been designed to reduce wound complications in a population typically at risk for problematic wound healing. Most studies have shown a reduction in such wound healing complications and improved patient comfort, which may result in fewer postoperative visits. The technique of endoscopic saphenous vein harvest is described, and the current limitations of the procedure are discussed.

Angioscopes↗
PubMed1999

Endovascular in situ bypass.

The history of arterial bypass dates back to the turn of the century. Recent advances have reduced the significant morbidity of some of these procedures.

Angioscopes↗
PubMed1994

Angioscopy-guided placement of balloon-expandable stents in the treatment of experimental carotid aneurysms.

This study was designed to assess the efficacy of a metallic, rigid, balloon-expandable stent (Palmaz-Schatz) for occlusion of an aneurysm. First, a glass model of two types of aneurysms was constructed, one simple lateral aneurysm and one lateral aneurysm with a side branch. After placement of the stent, the flow towards the distal, post-aneurysmal part of the glass tube was increased with immediate reduction of the flow towards the aneurysm. Beside some turbulences around the struts of the stent there was some inflow of dye into the aneurysm with partial and delayed filling of the aneurysm and delayed washout of the dye from the aneurysm. The same observations could be made with the side-branch aneurysm model. Although parts of the struts involved the ostium of the side branch, there was no flow alteration towards this branch. Second, 10 experimentally constructed aneurysms of the carotid artery in beagles were treated with stents. These stents were placed transfemorally and, since the stents were barely visible under fluoroscopy, angioscopy was performed before and after stenting in order to improve positioning of the stent. In 8 out of 10 cases placement of the stent resulted in an immediate complete occlusion of the aneurysm with remaining patency of the carotid artery. In the other 2 cases, a delayed, but complete occlusion was achieved. In one case, the carotid artery was completely occluded at a follow-up angiography after two weeks, probably induced by intimal damage during insertion of the stent. In two other cases, there was considerable stenosis of the carotid artery due to intimal proliferation.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioscopes↗
PubMed1999

A new instrument for hemostatic vascular management in endoscopic surgery: diode laser (STATLase-SDL) and its handpiece (dual hook).

OBJECTIVE: The authors described experimental data in hemostatic vascular transection using a STATLase-SDL with a 780-865 nm GaA/As diode wavelength and its handpiece, Dual Hook (DH). SUMMARY BACKGROUND DATA: The STATLase-SDL and DH are newly developed devices for endoscopic surgery. It seems that the device has improved hemostatic cutting ability. METHODS: The DH was applied to the abdominal aorta (< 2 mm) of Japanese white rabbits (n = 15) under general anesthesia. Tissue temperature during laser transection and interluminal bursting pressures were measured. Histopathological examinations at the cut end were carried out by hematoxylin-eosin (H&E) and elastica Van Gleson's (EVG) stainings. To investigate short-term effects 11 days postoperatively, the cut ends of the vessels were examined histologically in the heminephrectomy group. RESULTS: The DH hemostatistically cut through arteries up to 2 mm in diameter. Temperatures at the inner hook and in adjunct tissue were higher than 160 degrees C, while that at the outer hook was lower than 80 degrees C. The bursting pressures immediately after transection was 307.2 +/- 35.2 mm Hg at a laser power of 8 W (n = 5), and 295.6 +/- 28.7 mm Hg at 10 W (n = 5). Histological examination of the transected sites on the vessels revealed well-opposed tissue welding of the vascular wall. Absence of fragmentation in the welding of the internal elastic lamina is crucial for closure of the vessel stump. Up to 11 days postoperatively, there were no direct complications related to the use of the DH. CONCLUSIONS: The STATLase-SDL and DH have good hemostatic cutting ability and might be suitable for endoscopic surgery.

Angioscopes↗
PubMedDate not supplied

Virtual angioscopy using spiral CT and real-time interactive volume-rendering techniques.

Our purpose was to describe a technique for visualizing the inner contours of the vasculature using contrast enhanced spiral CT and volume rendering techniques. Because the technique is similar to using a camera to look inside vessels, we call this technique "virtual angioscopy." Preliminary results suggest virtual angioscopy using volumetric 3D rendering techniques as a potentially useful technique for the noninvasive evaluation of vascular pathology.

Adult↗
PubMed1993

Percutaneous coronary angioscopy: applications in interventional cardiology.

We performed percutaneous coronary angioscopy in 35 patients to study the surface morphology of coronary artery lesions. Twenty-five patients had angioscopy performed in conjunction with PTCA, including 20 patients with de novo lesions (16 patients with unstable angina, four patients with stable angina), and five patients with restenosis lesions. Ten cardiac transplant patients had angioscopy performed in conjunction with annual follow-up angiography in attempt to identify accelerated atherosclerotic lesions. There were no complications of angioscopy in any patient. There were no intracoronary thrombi seen either by angiography or angioscopy in the stable angina patients. In the unstable angina group, angiography identified thrombus in 2 out of 16 (12.5%) versus 15 out of 16 (94%) (P less than 0.001) with angioscopy. Following angioplasty, dissections were seen angiographically in 7 out of 16 (44%) of patients versus 16 of 16 (100%) of the patients by angioscopy (P less than 0.01). Restenosis lesions were characterized by a white, fibrous appearance instead of the usual yellow color of primary atherosclerotic lesions. In the ten cardiac transplant patients, angioscopy appeared to be more sensitive than angiography for the detection of atherosclerosis. Yellow (atherosclerotic) and white (fibrotic) plaques were seen in the transplant patients, which often were not detected by angiography. In summary, angioscopy is an excellent tool for visualizing the surface morphology of coronary artery lesions. The clinical indications for angioscopy remain undefined at present.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗