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PubMed2005

Angioscopic follow-up study of coronary ruptured plaques in nonculprit lesions.

OBJECTIVES: Changes of ruptured plaques in nonculprit lesions were evaluated using coronary angioscopy. BACKGROUND: The concept of multiple coronary plaque ruptures has been established. However, no detailed follow-up studies of ruptured plaques in nonculprit lesions have yet been reported. METHODS: Forty-eight thrombi in 50 ruptured coronary plaques in nonculprit lesions in 30 patients were identified by angioscopy. The percent diameter stenosis (%DS) at the target plaques on quantitative coronary angiographic analysis and the serum C-reactive protein (CRP) level were measured. RESULTS: The mean angioscopic follow-up period was 13 +/- 9 months. Thirty-five superimposed thrombi still remained at follow-up, and the predominant thrombus color changed from red (56%) at baseline to pinkish-white (83%) at follow-up. The healing rate increased according to the angioscopic follow-up period (23% at </=12 months vs. 55% at >12 months, p = 0.044). The %DS at the healed plaque increased from baseline to follow-up (12.3 +/- 5.8% vs. 22.7 +/- 11.6%, respectively; p = 0.0004). The serum CRP level in patients with healed plaques (n = 10) was lower than that in those without healed plaques (n = 19; 0.07 +/- 0.03 mg/dl vs. 0.15 +/- 0.11 mg/dl, respectively; p = 0.007). CONCLUSIONS: The present study demonstrated that: 1) ruptured plaques in nonculprit lesions tend to heal slowly with a progression of angiographic stenosis; and 2) the serum CRP level might reflect the disease activity of the plaque ruptures.

Adult↗
PubMed1999

Angioscopic complex lesions are predominantly compensatory enlarged: an angioscopy and intracoronary ultrasound study.

OBJECTIVES: Atherosclerotic remodeling of the coronary artery may lead to compensatory enlargement or to shrinkage. Post-mortem data suggest a relation between compensatory enlargement and histopathological markers of plaque vulnerability. In patients that required a coronary intervention, we investigated retrospectively the relation between the angioscopic appearance and the remodeling mode of the culprit lesion. METHODS: In 34 patients, coronary angioscopy and intracoronary ultrasound (ICUS) imaging was performed across the culprit lesion before the intervention. Only single de novo lesions were included. With angioscopy, lesions with a smooth surface without thrombus were classified as smooth, whereas lesions with an irregular surface with or without thrombus were classified as complex. With ICUS, remodeling of the culprit lesions was determined by the relative cross-sectional vessel area (lesion vessel area/reference vessel area) x 100%. Lesions were divided into three groups: compensatory enlargement (relative vessel area > or = 105%), no-remodeling (relative vessel area between 95 and 105%) and shrinkage (relative vessel area < or = 95%). RESULTS: In 22 patients good images were obtained with both imaging modalities. More complex lesions were compensatory enlarged compared to shrunken lesions, whereas more smooth lesions were shrunken compared to compensatory enlarged lesions, 8/9 versus 2/7 and 5/7 versus 1/9, respectively (p = 0.035). CONCLUSIONS: In patients selected for coronary intervention, angioscopic complex atherosclerotic lesions were found predominantly in compensatory enlarged arterial segments, whereas smooth lesions were found predominantly in shrunken arterial segments.

Adult↗
PubMed1992

Clinical experience of laser angioplasty with angioscopic guidance.

Since 1986, intraoperative angioscopic observations have been followed by the study of laser angioplasty experimentally and clinically. The healing process of the lased arterial wall initially was evaluated angioscopically in the canine model. The lased area was observed as a crater covered with char soon after laser irradiation. One week after laser irradiation, subintimal bleeding around the crater and a small fresh thrombus on the crater were seen in some cases. Four weeks after laser irradiation, the crater was covered with new endothelium. In this experimental study angioscopy provides information which cannot be obtained by other means.

Aged↗
PubMed1993

Effects of ultrasound energy on total peripheral artery occlusions: initial angiographic and angioscopic results.

Ultrasonic energy has been shown to ablate atherosclerotic plaques and arterial and venous thrombi. We used an ultrasonic angioplasty device developed by our group in ten patients with totally occluded femoral artery during surgical bypass. Ultrasonic angioplasty was performed with a 130-cm long and 0.8-cm diameter titanium probe with a 2- or 2.5-mm titanium ball-tip. In one patient, angioplasty could not be performed. Angiographic and angioscopic examination were performed before and after angioplasty in nine patients. Before ultrasound recanalization, angioscopic examination showed that the proximal end of the occlusion was formed by atheromatous material in 3 cases, red thrombus in 3 cases, amd white thrombus in 3 cases. After ultrasound recanalization, angioscopy showed residual stenosis at the site of entry in only one case. In three other cases, the artery was free of residual stenosis without persistent clot. In the five other patients, a residual stenosis was present beyond the proximal occlusion point with some fibrin mesh and small clots. At angiography, flow was restored in 4 cases; in 4 patients flow rate of entry was slow in the distal segment; and in 1 patient, the distal arterial bed could not be opacified. Altogether, ultrasonic angioplasty was able to recanalize a complete occlusion in nine out of ten patients, with partial or complete dissolution of clots and with no complication. At its present stage of development, adjunctive balloon angioplasty would be needed in most cases to obtain unrestricted flow and unsignificant residual stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Antithrombin and thrombolytic effects of a new antithrombin agent: angioscopic and angiographic comparison with heparin or batroxobin.

The antithrombotic effect of three different types of antithrombotic agents (antithrombin:argatroban, heparin, defibrinogenating agent:batroxobin) were evaluated in canine coronary and iliac arteries. An occlusive thrombus was produced by balloon injury. One of the three agents was infused intravenously at 1 hour after thrombus formation (heparin 250 U/kg, argatroban 0.5 mg/kg, batroxobin 0.5 U/kg) and the effect of thrombus size reduction was evaluated. On the contralateral side of the iliac artery, the preventive effect of these agents on thrombus formation was evaluated after balloon injury. In the iliac artery, angioscopic percent area obstruction by the thrombus before and 60 minutes after treatment reduced from 69% to 32% in the argatroban group, and from 64% to 51% in the batroxobin group (P < 0.0001 and P < 0.05, respectively). No significant change was observed in the heparin group. Angiography demonstrated the same trend. The percent area stenosis with thrombus at 60 minutes following balloon injury was 0.75% in the argatroban group, 18.9% in the heparin group (P < 0.05 vs argatroban), and 12.9% in the batroxobin group. Thrombus size at the treated site was smaller than that at the control site in all three groups (P < 0.05 vs control). In the coronary artery, angioscopic percent area obstruction by the thrombus before and 60 minutes after treatment reduced from 84% to 53% in the argatroban group, and from 86% to 68% in the batroxobin group (P < 0.0001 and P < 0.05, respectively). No significant change was observed in the heparin group. Angiography also demonstrated the same trend. The activated partial thromboplastin time (APTT) was prolonged to 189% of the control value with argatroban and to 1253% of the value with heparin (P < 0.0001). Fibrinogen was markedly reduced with batroxobin. These results showed that both the antithrombin agent and the defibrinogenating agent have a preventive effect on thrombus formation and the effect on thrombus size reduction, without marked prolongation of the APTT.

Angiography↗
PubMed1995

Relation of coronary angioscopic findings at coronary angioplasty to angiographic restenosis.

BACKGROUND: Discordant results have been reported regarding morphological predictors of restenosis after percutaneous transluminal coronary angioplasty (PTCA). These discrepancies may be related to the limitations of angiography in the study of plaque morphology. METHODS AND RESULTS: We studied 117 consecutive patients who underwent successful PTCA and who underwent coronary angioscopy before and immediately after the procedure. Angiographic follow-up was performed in 99 (85%) patients. We analyzed the relationship between angioscopic variables at the time of PTCA and the occurrence of restenosis assessed by quantitative coronary angiography. Plaque shape and color had no effect on late loss in luminal diameter (late loss: smooth lesions, 0.55 +/- 0.68 mm; complex lesions, 0.76 +/- 0.60 mm; white plaques, 0.51 +/- 0.56 mm; yellow plaques, 0.65 +/- 0.72 mm; P = NS). An angioscopic protruding thrombus at the PTCA site was associated with significantly greater loss in luminal diameter (late loss: no thrombus, 0.47 +/- 0.54 mm; lining thrombus, 0.59 +/- 0.67 mm; protruding thrombus, 1.07 +/- 0.77 mm; P < .05). Dissection assessed by angioscopy immediately after PTCA had no effect on late loss in luminal diameter (late loss: no dissection, 0.60 +/- 0.60 mm; simple dissection, 0.82 +/- 0.75 mm; complex dissection, 0.57 +/- 0.80 mm; P = NS). CONCLUSIONS: These results show that coronary angioscopy may be helpful in predicting the risk of restenosis after PTCA. The high rate of angiographic recurrence observed when PTCA is performed at thrombus-containing lesions supports a role for thrombus in the process of luminal renarrowing after PTCA.

Aged↗
PubMed1996

Angioscopic predictors of early adverse outcome after coronary angioplasty in patients with unstable angina and non-Q-wave myocardial infarction.

BACKGROUND: Clinical and angiographic criteria have a limited ability to predict adverse outcome in patients with unstable angina who are undergoing percutaneous transluminal coronary angioplasty (PTCA). We investigated whether the use of angioscopy can improve prediction of early adverse outcome after PTCA. METHODS AND RESULTS: Angioscopic characterization of the culprit lesion was performed before PTCA in 32 patients with unstable angina and 10 with non-Q-wave infarction. Seven patients (17%) had an adverse outcome (myocardial infarction, repeat PTCA, or need for coronary artery bypass graft surgery) within 24 hours after PTCA. Six of 18 patients with a yellow culprit lesion had an adverse outcome compared with 1 of 24 in whom the culprit lesion was white (P = .03). Six of 20 patients with plaque disruption suffered an adverse outcome compared with 1 of 22 with nondisrupted plaques (P = .04). Six of 17 patients with intraluminal thrombus had an adverse outcome, whereas only 1 of 25 patients without thrombus suffered an adverse outcome (P = .01). Yellow color, disruption, and thrombus at the culprit lesion site were associated with an eightfold increase in risk of adverse outcome after PTCA. The prediction of PTCA outcome based on characteristics of the plaque that were identifiable by angioscopy was superior to that estimated by the use of angiographic variables. CONCLUSIONS: In patients with unstable angina and non-Q-wave infarction, angioscopic features of disruption, yellow color, or thrombus at the culprit lesion site can identify patients at high risk of early adverse outcome after PTCA. Angioscopy was superior to angiography for prediction of PTCA outcome.

Adult↗
PubMed2005

Distal protection improved reperfusion and reduced left ventricular dysfunction in patients with acute myocardial infarction who had angioscopically defined ruptured plaque.

BACKGROUND: Distal protection, in the Saphenous Vein Graft Angioplasty Free of Emboli (SAFER) trial, is demonstrated to prevent distal embolism in the percutaneous coronary intervention of saphenous vein graft. However, in the Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial, it was not effective in the percutaneous coronary intervention of native coronary arteries in patients with acute myocardial infarction (AMI). We hypothesized that its effectiveness would be determined by lesion characteristics. Therefore, we classified the type of culprit lesion by angioscopy and examined its influence on the effectiveness of distal protection, comparing patients with AMI treated with and without distal protection. METHODS AND RESULTS: Consecutive patients with AMI treated without distal protection (n=110) from July 2000 to July 2002 and those treated with distal protection (n=81) from July 2002 to July 2004 were included. Patients in each group were subdivided according to whether or not they had angioscopically defined ruptured plaque at culprit lesion. Among those groups, incidence of no-reflow phenomenon, ST-segment resolution, myocardial blush grade, and left ventricular ejection fraction at 6 months were compared. Aspirated samples by distal protection were semiquantitatively and histologically analyzed and compared between patients with and without ruptured plaque. No-reflow phenomenon was most frequently (P<0.05) observed in patients with ruptured plaque treated without distal protection. ST-segment resolution (68+/-15% versus 40+/-21%, P<0.001), myocardial blush grade (2.6+/-0.5 versus 1.8+/-0.3, P<0.001), and left ventricular ejection fraction (47.2+/-6.7% versus 41.0+/-9.7%, P<0.01) were improved by distal protection among patients with ruptured plaque but not among patients without ruptured plaque. Aspirated samples >1 mm were detected more frequently (97.3% versus 78.5%, P<0.05) in patients with ruptured plaque than those without ruptured plaque. Histologically, aspirated samples contained plaque debris (95.3% versus 31.1%, P<0.05) more frequently in patients with ruptured plaque than in those without ruptured plaque. CONCLUSIONS: Distal protection reduced microcirculation damage and left ventricular dysfunction in patients with AMI who had angioscopically defined ruptured plaque. Distal embolization of plaque debris was detected more frequently in patients with ruptured plaque. These results suggest that microcirculation damage and left ventricular dysfunction are increased mainly by distal embolization of plaque debris rather than of thrombus.

Biopsy, Needle↗
PubMed2002

Heparin-coated versus uncoated Palmaz-Schatz stent in native coronary circulation. A randomized study with blind angioscopic assessment.

UNLABELLED: The increasing use of stenting to treat more complex lesions and highly thrombogenic situations still carries higher risk for subacute stent thrombosis. To assess new heparin-coated stents in a more stringent reality, 40 consecutive patients were randomized in 1:1 ratio to receive either heparin-coated (group 1, 25 stents) or uncoated Palmaz-Schatz stents (group 2, 32 stents). The two groups were similar in baseline clinical, pre-and post-procedural angiographic and angioscopic characteristics. High pressure stent deployment without intravascular ultrasound guidance was used. All pts received antiplatelet agents alone. We applied serial angioscopy (baseline and on 7th day) to evaluate thrombus formation and quantitative coronary angiography (QCA) to define late (6 months, n=39, 100% the eligible pts) neointimal regrowth. There was one subacute stent thrombosis with subsequent acute myocardial infarction and death in the uncoated group. CONCLUSION: The implantation of heparin-coated stents in nonselected population is well tolerated and associated with no clinical or angioscopic evidence of new thrombus formation, resulting in favorable long-term clinical and angiographic outcome.

Anticoagulants↗
PubMed2002

Preoperative duplex-derived parameters and angioscopic evidence of valvular incompetence associated with superficial venous insufficiency.

PURPOSE: To determine if an association exists between duplex-derived parameters and intraoperative angioscopic findings of valvular incompetence. METHODS: Preoperative duplex scanning and intraoperative angioscopy were performed on 153 limbs in 116 patients (84 women; mean age 53 years, range 24-79) with superficial venous incompetence (SVI). The duplex parameters of vein diameter at the saphenofemoral junction (SFJ), reflux duration, and peak retrograde reflux velocity at the SFJ were analyzed among SVI patients categorized by intraoperative angioscopy as type I (valves with elongated and atrophic cusps), type II (valves with expanded and depressed commissures with cusp changes), type III (cusps with other deformities), or type IV (absent valves). RESULTS: There were 33 limbs with type I valves, 56 with type II, 25 with type III, and 39 with type IV. Among the 89 limbs with type I or II valves, 64 (71.9%) had a peak velocity <30 cm/s, while only a quarter of the limbs with type III or IV values had a velocity <30 cm/s. The majority of patients with types I or II valves had a vein diameter <0.9 cm (25 [75.8%] type I and 37 [66.1%] type II). The sensitivity, specificity, and predictive value for identifying type I and II valve lesions were maximized at 90.0%, 66.7%, and 77.8%, respectively, when vein diameter <0.9 cm was combined with a peak reflux velocity >30 cm/s. CONCLUSIONS: These data suggest that a combination of variables determined by preoperative duplex scans may correlate to the severity of valvular deformity determined by direct angioscopic inspection.

Angioscopy↗
PubMed2002

Angioscopic evaluation of stabilizing effects of an antilipemic agent, bezafibrate, on coronary plaques in patients with coronary artery disease: a multicenter prospective study.

To evaluate the stabilizing effects of an antilipemic agent, bezafibrate, on coronary plaques, we carried out a prospective angioscopic and angiographic open trial. From April 1997 to December 1998, 24 patients underwent coronary angioscopy of plaques in non-targeted vessels during coronary interventions and then again 6 months later. The patients were divided into control (10 patients, 14 plaques) and bezafibrate (14 patients, 21 plaques) groups. Oral administration of bezafibrate (400 mg/day) was started immediately after the intervention and was continued for 6 months. The vulnerability score was determined based on the angioscopic characteristics of plaques and compared before and 6 months later. Six months later, the vulnerability score was reduced (from 1.6 to 0.8; P<0.05) in the bezafibrate group and unchanged (from 1.4 to 1.3; NS) in the control group. In the bezafibrate group, the changes in the vulnerability score were not correlated with those in % stenosis or minimal lumen diameter. The plasma total cholesterol level (T-C) was unchanged, triglyceride level (TG) was decreased, and high density lipoprotein cholesterol level (HDL-C) was increased in the bezafibrate group, but were unchanged in the control group. In the bezafibrate group, T-C and TG were decreased and HDL-C was increased in patients with a reduced vulnerability score but were unchanged in those with an unchanged score. These results indicate that 6 month administration of bezafibrate stabilizes coronary plaques and that the stabilization is not correlated with angiographic changes.

Angioscopy↗
PubMed1992

[Angioscopic prediction of late vascular patency after transluminal balloon angioplasty for arteriosclerotic obstructions of the artery of the lower extremities].

Arterial occlusion or stenosis of the lower extremity due to arteriosclerosis obliterans (ASO) was treated by transluminal balloon angioplasty (TBA). Angioscopic observation of the vascular lumen, performed immediately after TBA, provided five major findings: (1) abrasion of the intima, (2) irregularity of the lumen due to poor expansion, (3) laceration of the wall, (4) mural thrombus and (5) calcification. The degree of each of these abnormalities was scored with a 3-grade scale (0, 1 and 2), and scores for the 5 abnormalities were totaled in each patient. Analysis of the relationship between scores and postoperative vascular patency demonstrated that patients without vascular patency in the early (within 6 months) or late period (6 months or more) after the operation had higher total scores as compared to those in whom the vessel remained patient in the corresponding postoperative periods (p less than 0.01, p less than 0.05). Among others, patients with a total score over 5 showed markedly lower patency rates in the early period (10%) as well as late period (0%) after the operation (p less than 0.01). These results indicate the usefulness of post-TBA angioscopic observation of vascular lumen in predicting the long-term patency of the vessels operated on.

Aged↗
PubMed1989

Intraoperative angioscopically monitored laser-assisted angioplasty in treating lower-extremity atherosclerotic occlusive disease.

As part of an ongoing multi-institutional study, our surgical center offered laser-assisted angioplasty to patients with significant, documented lower-extremity atherosclerotic occlusive disease, as an alternative to standard femoral-popliteal or femoral-tibial bypass. During the 1st 12 months of the study (September 1987 through August 1988), 31 patients had laser-assisted angioplasty in 34 limbs. The procedures were performed with an argon-powered laser probe that features a heated metallic tip and a window that furnishes 20% of the laser energy as a direct argon laser beam. Angioscopic monitoring was provided in each case. The immediate recanalization rate was 82% (28 of 34 limbs). After a follow-up period of 6 to 18 months (mean, 14 months), the patients continue to show clinical improvement of pretreatment symptoms, and noninvasive studies continue to reveal improved segmental arterial pressures. On the basis of this experience, we conclude that angioscopically monitored laser-assisted angioplasty has a role in the management of lower-extremity atherosclerotic occlusive disease.

Journal Article↗
PubMed2006

Angioscopically-determined extent of coronary atherosclerosis is associated with severity of acute coronary syndrome.

OBJECTIVE: Some patients with acute coronary syndrome (ACS) have large myocardial infarction but others have small or no infarction. However, what makes this difference has not been clarified. We compared the angioscopic findings between those two categories of ACS patients and examined the association between the severity of ACS and the morphology of both culprit lesion and nonculprit coronary segments. METHODS: Prospectively and consecutively enrolled patients with ACS were classified as CK-elevation-ACS (CKE-ACS; n = 54) or non-CK-elevation-ACS (NCKE-ACS; n = 22). Patients were diagnosed as CKE-ACS when the elevation (greater than twice the normal upper limit) of CK-MB was detected; otherwise, patients were diagnosed as NCKE-ACS. They all underwent emergent catheterization and PCI of the culprit lesion. The entire culprit artery was observed by angioscopy, and the prevalence of thrombus and the color grade of yellow plaques were evaluated. The color grade of yellow plaques were classified as 0 (white), 1 (slight yellow), 2 (yellow), or 3 (intense yellow) according to the standard colors. The color grade of culprit plaque (CC), number (NP) and maximum (MC) color grade of yellow plaques in the nonculprit segments, plaque index (PI = N x MC), and prevalence of thrombus at the culprit lesion (CT) and in the nonculprit segments (NT) were compared between CKE-ACS and NCKE-ACS patients. RESULTS: CC (1.9 +/- 0.9 vs. 1.7 +/- 0.8; p = 0.3) and CT (93% vs. 77%; p = 0.06) were not significantly different between CKE-ACS and NCKE-ACS patients, however, NP (2.2 +/- 1.6 vs. 1.4 +/- 1.2; p = 0.03), MC (1.8 +/- 0.9 vs. 1.2 +/- 0.9; p = 0.008), PI (4.8 +/- 4.4 vs. 2.4 +/- 3.1; p = 0.03), and NT (39% vs. 11%; p = 0.02) were significantly higher in CKE-ACS than in NCKE-ACS patients. CONCLUSION: Although the culprit lesions of CKE- and NCKE-ACS had similar yellow color grades, the culprit lesions of CKE-ACS showed a trend towards a higher prevalence of thrombus. A greater number of yellow plaques of higher color grades and a higher prevalence of thrombosis in the nonculprit segments were detected in CKE-ACS compared to NCKE-ACS patients. The angioscopically-determined extent of coronary atherosclerosis appeared advanced in CKE-ACS patients compared to NCKE-ACS patients.

Acute Disease↗
PubMed1995

In vivo angioscopic detection of the damaged endothelium on the atheromatous plaque: application with vital staining by methylene blue.

We attempted to detect the lesion of the damaged endothelium on the atherosclerotic plaque in vivo with dye and angioscope. The plaques were induced on the aortae of rabbits by the continuous mechanical injury with the insertion of the polyethylene tube and feeding with 2% cholesterol-added diet. We observed the some plaques could be stained with 5 x 10(-2) mol/L methylene blue by angioscope. Control aorta, without any stimulations on the aorta, could not be stained. One month after injury and cholesterol feeding the plaques were stained. In such plaques, the lack of the endothelium and the existence of the lipid-containing cell in the intima was observed. However, the plaques of the aorta 6 months after finishing these procedures could not be stained. In these plaques, the morphological characteristics known as the regression of the atheromatous plaque, ie, the regeneration of the endothelium, the thick collagen layer on the plaque and the massive calcification of the plaque were observed. The results obtained were as follows. (1) The atheromatous lesion with the damaged endothelium could be detected in vivo by our vital staining method. (2) The atheromatous plaques stained in vivo are the lesion with complication and enhanced permeability. (3) The slightly stained plaques indicate the lesions with regression and lost high permeability. (4) Our method would be able to add important information on the atheroscrelotic lesions in the clinical situations than that now we perform.

Angioscopy↗
PubMedDate not supplied

[External valvuloplasty under preoperative angioscopic control].

Intraoperative angioscopy was applied to evaluate the venous valvular incompetence and perform external valvuloplasty in case of venous reflux. Sixty-seven limbs, 43 cases of primary varicose veins were examined using intraoperative angioscopy and the angioscopic findings of the incompetent venous valves were classified into three types as follows: valves with elongated and atrophic cusps 43 (50%)--type I, values with expanded and depressed commissures 36 (42%)--type II, and valves with perforated cusps or other changes 7 (8%)--type III, according to the angioscopie findings, external valvuloplasty was done in 31 subterminal valves of the long saphenous veins and 7 highest valves of the superficial femoral vein. Our external valvuloplasty consisted of two techniques. The first was the total plication technique for valvular annulus by a running suture of prolene and the second was by the venocuff sleeve of the autogenetic femorofascial band. The degree of plication was decided by angioscopic observation. Postoperative observation periods were from 2 to 28 months. There was no recurrence of varicose veins or prominent venous reflux. The application of intraoperative angioscopy is therefore useful for the choosing appropriate surgical procedures and for the evaluation of venous valvuloplasty.

Adult↗
PubMed1996

[Angioscopic in-situ arterial bypass for lower extremity revascularization].

The authors' initial experience of angioscopic in-situ arterial bypass of 37 extremities reveals that angioscopy can be used to assist complete valvular ablation and precise location and ligation of tributaries of saphenous vein grafts, avoiding postoperative arterial-venous fistula and warm ischemic injury to grafts. Angioscopy is also used to perform intraoperative completion inspection of the grafts and anastomoses. The designed biocomposite graft and common ostium technique promotes the usage rate of the limited autogenous vein grafts and enlarges the diameter of grafts and blood flow through the distal anastomosis. Because of the above new series of procedures, the extremity salvage rate in this study was 34/37 limbs. During the follow-up period of 2-18 months, all anastomoses were patent. The preoperative ankle and toe pressure of 3.5 +/- 0.2 kPa and 2.0 +/- 0.1 kPa respectively rose to 5.4 +/- 0.1 kPa and 3.8 +/- 0.2 kPa postoperatively. We conclude that angioscopic in-situ arterial bypass surgery is of practical value and specially advantageous in lower extremity revascularization.

Adult↗