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At least 433 records · Page 24Linked to original sources
PubMed1994

The clinical utility of angioscopy during intracoronary stent implantation.

Angiographic evidence of thrombus may have important implications during coronary stent deployment procedures. The periprocedural presence of thrombus has been shown to increase the risk of subsequent stent thrombosis. Coronary angioscopy is a new technology that may prove more accurate for the detection of coronary thrombus. Angiographic filling defects suspicious for thrombus were observed in 15 (22%) of 64 patients undergoing coronary angioscopy during stent implantation procedures. Angioscopy confirmed the presence of thrombus in 9 (60%) of these 15 patients. Protruding thrombus was found in four cases and only mural thrombus in five. In six cases (40%) thrombus was not visualized and angioscopy provided an alternative explanation for the angiographic filling defect. Bulky atherosclerotic plaque was seen protruding into the lumen in two cases, disection with protruding fronds of tissue was found in three cases and a ruptured venus valve was found in one final case. Thrombolytic therapy was administered in all four cases containing protruding thrombus, in only two of the five cases containing mural thrombus, and in none of the cases where thrombus was not visualized. Angioscopy was more accurate than angiography for the diagnosis of thrombus and allowed more precise tailoring of the intervention to the underlying anatomical substraight. This resulted in an excellent clinical outcome, with no episodes of stent thrombosis and limitation of the risks associated with thrombolytic therapy to only those patients at increased risk of a thrombotic complication.

Adult↗
PubMed1999

Virtual CT intravascular endoscopy of the aorta: pierced surface and floating shape thresholding artifacts.

Two types of artifacts may appear in virtual computed tomographic endoscopic views of the aorta rendered at different threshold levels: pierced surface and floating shape artifacts. A positive correlation was found between mean attenuation of the aorta and the threshold levels at which these artifacts appeared. The correlation was statistically significant (0.71 < or = r < or = 0.86) for floating shape. An artifact-free threshold range can be predicted on the basis of aortic enhancement.

Adult↗
PubMed1993

XeCl laser-induced fluorescence of atherosclerotic arteries. Spectral similarities between lipid-rich lesions and peroxidized lipoproteins.

Autofluorescence spectroscopy of arterial surfaces provides information about the distribution and composition of atherosclerotic plaques. The aim of the study was to determine whether accumulation of peroxidized lipoproteins in arterial walls, a process postulated to play a role in initiating atherosclerotic changes, can be demonstrated by fluorescence spectroscopy. XeCl excimer laser (308 nm)-induced fluorescence of human aortas containing early lipid-rich noncollagenous lesions exhibited marked red shifts and broadening of the fluorescence spectra compared with spectra from nonatherosclerotic aortas. Similar profiles were observed in spectra obtained from oxidatively modified low density lipoprotein but not native low density lipoprotein. In hypercholesterolemic rabbits with early foam cell lesions, spectral shifts resembled those of oxidized beta-very low density lipoprotein, the major lipoprotein accumulating in arteries of rabbits fed cholesterol. XeCl laser-fluorescence spectroscopy of arterial surfaces may be useful for the identification of arteries accumulating modified lipoproteins (oxidized low density lipoprotein), a chemical change indicative of atherosclerosis in its early and probably reversible stages.

Angioscopes↗
PubMed2000

A retrospective comparative study of open and endoscopic saphenous vein harvesting.

PURPOSE: To compare the operative variables, complications, and potential benefits of endoscopic saphenous vein harvesting (ESVH) with traditional open vein retrieval for coronary artery bypass grafting (CABG). METHODS: Data were collected retrospectively on 212 consecutive CABG patients from whom saphenous veins were harvested by one surgeon using either an open saphenous vein harvesting (OSVH) technique (n = 135) or ESVH (n = 77) performed with the ENDO-SAPH Vein Harvest System. Fifty-three patients underwent a purely endoscopic procedure, whereas 24 patients had either a combined endo-open procedure (n = 13) or were converted to an open technique (n = 11) because of equipment failure or adverse anatomical characteristics. Harvest time was measured from initial leg incision to aortic cross-clamping. Leg wound complications were evaluated on the basis of progressive severity. RESULTS: Harvest and procedural times were longer for the ESVH group (111 and 313 minutes, respectively) than for the OSVH patients (63 and 252 minutes, respectively, p < 0.001). Mean length of stay was not appreciably different: 11.7+/-6.2 days (range 3-52) for the OSVH group, compared with 11.0+/-6.0 days (range 3-41) for the ESVH patients (p = 0.40). Fewer complications occurred in the ESVH group when a purely endoscopic procedure was performed (17% versus 35% for OSVH, p = 0.012). Infection occurred in 1 OSVH and in 4 ESVH patients, but 3 of the endoscopic patients had a combined procedure. Bivariate correlational analysis showed that an increased number of incisions (r = 0.29, p < 0.01), obesity (r = 0.18, p < 0.01), and short stature (r = -0.16, p < 0.05) were associated with leg wound complications, but hierarchial stepwise regression analysis determined only short stature to be a predictive variable (beta = 0.17, R2 = 0.03). CONCLUSIONS: Despite increased operating time, ESVH results in fewer complications when a purely endoscopic procedure is performed.

Adult↗
PubMed2006

Prospective randomized study comparing the Teleflex Medical SaphLITE Retractor to the Ethicon CardioVations Clearglide Endoscopic System.

BACKGROUND: Several minimally invasive saphenous vein harvesting techniques have been developed to reduce morbidities associated with coronary artery bypass grafting. This prospective, randomized study was designed to compare two commonly used minimally invasive saphenous vein harvesting techniques, the SaphLITE Retractor System (Teleflex Medical) and the Clearglide Endoscopic Vessel Harvesting System (Ethicon CardioVations, Inc.). METHODS: Between January 2003 and March 2004, a total of 200 patients scheduled for primary, nonemergent coronary artery bypass grafting, with or without concomitant procedures were randomized into two groups: SaphLITE (n = 100) and Clearglide (n = 100). Pre-, intra- and postoperative data was collected and subjected to statistical analysis. Randomization provided homogenous groups with respect to preoperative risk factors. RESULTS: Harvest location for the SaphLITE group was thigh (n = 40), lower leg (n = 5) and both lower leg and thigh (n = 55). The location of harvest for the Clearglide group was thigh (n = 3), lower leg (n = 16) and both lower leg and thigh (n = 81). The mean incision length was 3.6 cm (range, 2-6) in the SaphLITE group versus 2.1 cm (range, 1-4) in the Clearglide group (p < 0.05). The total incision length was 12.9 cm versus 8.9 (p < 0.05) in the SaphLITE and Clearglide groups. Conversion to the open technique occurred in 5 SaphLITE patients and 7 Clearglide patients. Intraoperative leg exploration for bleeding occurred in two of the Clearglide patients and none of the SaphLITE patients. Post-operative complications specifically related to minimally invasive harvesting technique, including a two-week post-discharge visit, were not statistically different between the groups. CONCLUSION: The saphenous vein can be safely harvested utilizing the SaphLITE and Clearglide systems. While the Clearglide system allows for fewer incisions (number and length) and less harvest time, these benefits may be outweighed by the increased cost of the Clearglide system compared to the SaphLITE retractor.

Adult↗
PubMed2005

Micro-optical fiber probe for use in an intravascular Raman endoscope.

We believe that we have developed the narrowest optical-fiber Raman probe ever reported, 600 microm in total diameter, that can be inserted into coronary arteries. The selection of suitable optical fibers, filters, and a processing method is discussed. Custom-made filters attached to the front end of a probe eliminate the background Raman signals of the optical fiber itself. The experimental evaluation of various optical fibers is carried out for the selection of suitable fibers. Measurement of the Raman spectra of an atherosclerotic lesion of a rabbit artery in vitro demonstrates the excellent performance of the micro-Raman probe.

Angioscopes↗
PubMed1999

Minimally invasive saphenous vein harvesting: is there an improvement of the results with the endoscopic approach?

OBJECTIVES: In the postoperative course after conventional open removal of the greater saphenous vein, wound healing disturbances are common and often painful. Therefore the primary goal of this investigation was to prove the safety and practicability of this new less invasive technique for saphenous vein harvesting and the effect on complications and morbidity. METHODS: The study comprised 103 coronary artery bypass grafting (CABG) patients with an endoscopic approach to harvest the saphenous vein (MIVH). We used the VasoView II system developed by Origin, and compared the intraoperative procedure time and the clinical results with 105 equivalent patients in which a conventional open technique was used. RESULTS: In 101 patients endoscopic vein harvesting was successful; a conversion into open technique was necessary in two patients. On average 2.6 vein segments could be harvested in the endogroup versus 2.9 segments in the opengroup. The mean procedure time was 13.2 min per segment in the endogroup compared to 12.2 min per segment in the opengroup. Relevant hematoma were found in 29 patients (27.6%) of the opengroup, whereas only nine patients (8.7%) of the endogroup revealed severe hematoma. Infection was apparent in nine patients (8.5%) after conventional vein harvesting. Two infections were found after endoscopic intervention. CONCLUSIONS: Endoscopic saphenous vein harvesting as part of a less invasive concept in cardiac surgery is a safe and after the learning curve, fast alternative to harvest the saphenous graft. The cosmetic result is excellent and the complication rate seems to be lower. It must be noted however, that the cost effectiveness of the method has to be proved and that further histological and functional studies are needed in order to check the intimal structure of the vein.

Angioscopes↗
PubMed1999

Routine minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients.

OBJECTIVE: Minimal invasive endoscopic vein harvesting has not gained widespread acceptance although potential improvements in wound healing and patient comfort are undebatable. The main objections to routine application have been impaired graft quality and prolonged operation time. The feasibility of introducing the minimal invasive approach to vein harvesting into a high volume cardiac bypass surgery program was to be investigated in 1400 patients. METHODS: Our preferred technique is based on standard videoscopic equipment for endoscopic surgery. No disposables are used. The subcutaneous tissue above the saphenous vein is tunnelled by exclusively sharp dissection. No shear stresses are applied to the vein graft or its side branches. Side branches are closed by clips or bipolar coagulation. The differences between endoscopic and conventional surgical vein harvesting with regard to operation time, graft quality, wound healing disturbances and postoperative pain were compared in two groups of 300 concurrently operated patients. Subsequently, a further 1100 patients underwent endoscopic vein harvesting, giving a total experience of 1400 endoscopic procedures. RESULTS: After a learning curve of approximately 100 procedures for an experienced surgeon, harvesting time using minimal invasive techniques was 16 +/- 4 min/graft vs. 10 +/- 2 min for the conventional technique (P < 0.01). Severe wound healing disturbances requiring re-intervention were observed in 0.1% following endoscopic harvesting, moderate wound healing disturbances were observed in 1.7% of patients. By comparison, conventional harvesting led to severe wound healing disturbances in 5% and to moderate disturbances in 8% (P < 0.05). Incidence of peri-operative myocardial infarction as an indirect measure of graft quality was 1.7% with endoscopic vs. 2.3% (n.s.) with conventional technique. Early postoperative mobilisation was faster, pain and need of analgesics were distinctly reduced in patients with endoscopic harvesting. Overall operation time was not significantly prolonged by the described technique. CONCLUSIONS: Minimal invasive endoscopic vein harvesting can be developed into a routine procedure resulting in a lower incidence of wound complications, less postoperative pain and much superior cosmetic results. Graft quality appears to be comparable to standard saphenectomy. There is, however, a higher demand of surgical training and expertise.

Aged↗
PubMed2000

Endoscopic saphenectomy for coronary artery bypass surgery: comparison of two techniques with and without carbon dioxide insufflation.

OBJECTIVE: To compare the clinical results of an initial experience with two techniques of endoscopic saphenectomy with and without gas insufflation. DESIGN: A retrospective study was performed between September 1998 and March 1999 on 40 patients who underwent endoscopic saphenectomy for coronary artery bypass graft without (group 1, n=15) and with (group 2, n=25) carbon dioxide insufflation. INTERVENTIONS: In both groups, the site of harvesting was at the knee through a 2 cm incision. In group 1, dissection was performed using a hand-held dissector while in group 2 dissection was performed after ensuring that there was a seal at the knee and insufflation of carbon dioxide. Collaterals were controlled with an endoclipper in group 1 and bipolar scissors in group 2. Intraoperative procedure time, length of the harvested vein and aspect of the thigh (ecchymosis, hematoma, infection) were recorded. RESULTS: Vein trauma occurred in four patients in group 1 (four of 15, 27%) and in one in group 2 (one of 25, 4%). Hematomas developed in four patients in group 1 (four of 15, 27%) and in one patient in group 2 (one of 25, 4%). Wound infection occurred in no patients in group 1 and in one patient in group 2. One patient in group 2 suffered carbon dioxide embolism with no untoward consequences. Conversion to an open technique was necessary in five patients in group 1 (five of 15, 33%) and in two patients in group 2 (two of 25, 8%). CONCLUSIONS: Endoscopic saphenectomy both with and without carbon dioxide insufflation is associated with a low infection rate, but vein trauma and wound hematomas are more common without carbon dioxide insufflation.

Angioscopes↗
PubMed1992

[Intravascular ultrasound: a new dimension of invasive vascular diagnosis].

Intravascular ultrasound is a new imaging modality which allows the visualization of the vessel wall in vivo and could thus become an important adjunct to conventional angiography. Using miniature high-frequency transducers mounted at the tip of flexible catheters, high-resolution cross-sectional images are created and displayed in real-time. Several investigations have shown good correlations between ultrasound and histologic or angiographic techniques for the measurement of cross-sectional dimensions. Atherosclerotic lesions can be characterized by their differences in echo-density as calcified, fibrous or lipoid. Initial clinical studies have demonstrated the possibility to detect acute changes, such as dissections, following PTCA and other interventions. Several potential clinical applications are being discussed, where intravascular ultrasound may yield valuable information in addition to that provided by angiography. If some important current limitations can be overcome, this method may add a new dimension to invasive vascular diagnostics.

Angiography↗
PubMed1992

Interventional neuroradiology.

Recent technical developments and improvements in angiographic equipment, variable stiffness microcatheters, embolic materials, and better training increased efficacy, safety, and growing acceptance of endovascular procedures by various specialties. Additional treatment options, frequently supplementary to neurosurgical procedures can be offered to patients with intracranial vascular lesions, using existing vascular pathways and avoiding the need for surgical exposure. For endovascular embolization of unclippable aneurysms coils which are soft, retrievable, and thrombogenic appear a better alternative than detachable balloons. New understanding and capabilities in brain arteriovenous malformations (AVMs) as an adjunct to microsurgical resection, or as the sole form of treatment may improve results and long-term outcome. Experience with intravascular thrombolysis and balloon angioplasty of extracranial and intracranial vessels will potentially improve neurological deficits in cerebrovascular or vasospastic occlusive disease. Safety, efficacy, and long-term follow up are needed to maintain and improve standards of practice and offer new therapeutic alternatives.

Angioplasty, Balloon↗