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At least 73 records · Page 4Linked to original sources
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↗
PubMed1995

The role of routine angioscopy in vascular access surgery.

PURPOSE: The purpose of this retrospective study is to describe our techniques, review our experience, and determine the feasibility, safety, and role of the routine use of angioscopy during primary and revision vascular access surgery. METHODS: Between February 1991 and October 1993, intraoperative angioscopy was routinely performed in 84 consecutive operations (51 patients) for vascular access surgery. We reviewed the videotaped recordings of the angioscopic studies together with the clinical data according to a predetermined protocol. RESULTS: There were 43 primary procedures (36 autogenous arteriovenous fistulas and 7 bridge graft fistulas) and 41 revision procedures for failed vascular access (7 autogenous arteriovenous fistulas and 34 graft bridge fistulas). In 20.9% of the primary vascular access procedures, abnormal endoluminal findings were noted. Based on these findings, only one additional intervention was performed. In revision vascular access surgery, abnormal endoluminal findings were noted in 92.7%, resulting in additional surgical interventions in 65.9% of the procedures. In the revised synthetic bridge graft fistulas, stenosis of the midgraft (n = 9) as a result of needle insertion for dialysis was more common than at venous anastomosis (n = 4). Detection and correction of endoluminal abnormalities resulted in a 30-day patency of 66.6% as opposed to 33.3% when none was detected (p < or = 0.012, Fisher's exact test). CONCLUSIONS: Routine angioscopy is technically feasible and can be performed safely in anuric patients during vascular access surgery. It provides additional and useful intraoperative information that may significantly alter the surgical procedure. Routine angioscopy may also provide new insights into the pathophysiology of vascular access failure.

Adult↗
PubMed2001

Completion angioscopy following carotid endarterectomy by the eversion technique or the standard longitudinal arteriotomy with patch closure.

INTRODUCTION: Technical defects are a potential cause of peri-operative strokes following carotid endarterectomy (CEA) by either the eversion technique or the standard method of longitudinal arteriotomy with or without patch closure. AIM: A non-randomised retrospective study was undertaken to assess the value of angioscopy for the identification of technical errors following CEA and to compare those detected following eversion and standard endarterectomy with patch closure. MATERIALS AND METHODS: Intra-operative completion angioscopy was performed following 110 CEAs (56 eversion, 54 standard). Angioscopy was omitted in 5 patients because of technical problems (2) or extreme shunt dependency (3). RESULTS: Significant technical defects were identified and corrected in 10 cases (9%) and were equally distributed between the eversion and standard procedures. There was no peri-operative stroke or death in this series. CONCLUSIONS: Significant residual defects may occur after CEA by either technique. Angioscopy allows their correction peri-operatively and has the potential to reduce peri-operative stroke.

Adult↗
PubMed1992

[Angioscopy in peripheral vascular surgery].

At Saint-Luc's Hospital of Montreal, between January 1, 1990 and February 1, 1991, 47 angioscopic procedures were done in 43 patients submitted to peripheral vascular reconstructions. The purpose of the study was to evaluate the role of angioscopy during those procedures. The operations were as follows: twenty femoropopliteal bypasses done with reversed saphenous vein, 15 done with in situ saphenous veins and 10 done with synthetic grafts. Two patients had popliteal embolectomies. Seventeen percent of the cases showed technical problems with the use of controlled angioscopy and were subsequently corrected. Three residual valves and one unsuspected venous stenosis were found in 15 in situ grafts, for a total of 27% correctible defects. In the reversed saphenous group, one case of venous sclerosis and one case of anastomotic stenosis were found for a total of 10%. For the synthetic grafts group we found an intimal flap distal to the anastomosis in one case (10%). Finally, we found a significant residual clot in one case (50%) after embolectomy. The technique of angioscopy is simple, the equipment reliable, and the learning period is short. Angioscopy is a very useful approach and should be readily available in the armamentarium of every vascular surgeon.

Adult↗
PubMed1990

Angioscopy for intraoperative management of thromboembolectomy.

Our experience with angioscopy suggests that direct visualization of the arterial lumen during thromboembolectomy procedures would provide a more reliable method of assessing luminal morphologic characteristics than angiography alone. We inspected 32 grafts (seven aortobifemoral, 18 infrainguinal bypass, and seven dialysis access fistula grafts) in 32 patients. Thirty-one patients had thrombotic events and one patient had an acute embolus. Angioscopy following standard catheter thrombectomy revealed significant amounts of retained thrombus or neointima in all thrombectomies. Angioscopic information from 18 patients with an infrainguinal bypass graft led to graft revision in six cases and placement of a new graft in 10 cases. One graft limb was replaced in seven aortobifemoral grafts, and multiple repeated thrombectomies were employed to extract debris in the remaining six cases. Repeated graft thrombectomy was also beneficial in dialysis access fistulas. Angioscopy allowed us to omit the completion angiogram and led to an improved technical result. We conclude that angioscopy is useful during thromboembolectomy procedures.

Aged↗
PubMed1992

Safety of saline irrigation for angioscopy: results of a prospective randomized trial.

This study evaluates the hemodynamic effects and safety of saline irrigation necessary to obtain high-quality completion angioscopic studies, as compared with standard completion arteriography during infrainguinal bypass grafting. One-hundred ten patients undergoing primary infrainguinal bypass grafting, were prospectively randomized to either arteriography (N = 50) or angioscopy (N = 60) for a completion study to monitor the bypass procedure. All patients were hemodynamically monitored with pulmonary artery catheters and arterial lines. The arteriography group received an average of 27 ml (range 8-60 ml) of contrast per completion study, with a total administered intraoperative fluid volume of 2095 ml (range 650-4000 ml). The angioscopy group received an average bolus of 321 ml (range 90-650 ml) of irrigation fluid per completion angioscopy study, with a total administered intraoperative fluid volume of 2140 ml (range 850-5000 ml). Transient increases in pulmonary artery systolic and diastolic pressures and central venous pressures were measured during angioscopy. Although these changes reached statistical significance, the changes were of minimal clinical relevance, 1.9 (= 4.5), 1.6 (= 3.0) and 1.4 (= 2.3) mmHg respectively, and returned to baseline levels within 30 minutes. Intraoperative intervention with vasodilators and diuretics, the perioperative cardiac morbidity, and less than 30 day mortality, was not different between the two groups. Pressures generated within 24 bypass grafts were within physiologic arterial range for most of the study. With careful angioscopic technique applied and high quality care extended to the patient, irrigation with saline solution is simple, effective and safe.

Angiography↗
PubMed1990

Angiography, angioscopy, and ultrasound imaging before and after percutaneous balloon angioplasty.

We report two patients undergoing peripheral percutaneous transluminal angioplasty in whom angiography, angioscopy, and ultrasound imaging were performed before and after balloon angioplasty. The first case with smooth atheroma diagnosed by angiography was found to have unrecognized partially occlusive thrombus by angioscopy. After angioplasty, an intimal tear was identified by angioscopy and ultrasound but it was not seen by angiography. The intravascular ultrasound image showed the tear to extend to the adventitia. In the second case, an apparently smooth intimal surface as imaged by angiography was found by angioscopy and ultrasound to have extensive damage, including subintimal hemorrhage, intimal flaps, and arterial dissection at the angioplasty site. These data suggest that the type of information derived from the three imaging techniques is quite different, and that each may have a specific role in intravascular diagnosis.

Aged↗
PubMed1991

Percutaneous coronary angioscopy in patients with restenosis after coronary angioplasty.

Percutaneous transluminal coronary angioscopy with a flexible steerable microangioscope was performed in five patients undergoing repeat angioplasty. Recurrent lesions were assessed by angioscopy before and after the angioplasty procedure. The most common surface morphology observed in these restenosis lesions was that of white unpigmented lesions consistent with the proliferation of fibrous tissue. Also noted during angioscopy was the presence or absence of thrombus or dissection in association with the lesions either before or after angioplasty. Filmy wisps of tissue, presumably intimal flaps, were commonly visualized after angioplasty. There were no complications related to angioscopy or angioplasty in these patients. The surface morphology of restenosis lesions appears to be different from that of primary atherosclerotic lesions. The lesions in these five patients with restenosis were generally white and fibrotic in appearance, as opposed to the pigmented yellow to yellow-brown lesions commonly seen in undilated atherosclerotic lesions. It was also noted that the presence of intracoronary thrombus was strongly associated with the clinical syndrome of unstable angina. These findings support the hypothesis that restenosis lesions are the result of a reparative process consisting of smooth muscle cell proliferation and fibrosis.

Adult↗
PubMed2001

Cystoid macular edema after pediatric intraocular lens implantation: fluorescein angioscopy results and literature review.

PURPOSE: To evaluate the occurrence of cystoid macular edema (CME) after lens extraction, anterior vitrectomy, and intraocular lens implantation (IOL) in children using angioscopy after administration of oral fluorescein. SETTING: Centers in Tamil Nadu, India, and Hong Kong, China. METHODS: This study comprised 18 children (28 eyes) who had cataract extraction, posterior capsulorhexis, anterior vitrectomy, and in-the-bag IOL implantation. The presence of CME was evaluated 1 week and 4 to 6 weeks after surgery using fluorescein angioscopy. RESULTS: Anterior chamber fibrin occurred in 4 eyes (14.3%). Fluorescein angioscopy was performed 1 week after surgery in all eyes and after 1 month in 25 eyes (89.3%). No eye demonstrated the presence of CME on fluorescein angioscopy. CONCLUSIONS: Cystoid macular edema did not occur in the early period after pediatric cataract surgery using current surgical techniques. Longer follow-up is required to ascertain the incidence of CME in the late postoperative period.

Capsulorhexis↗
PubMed1985

Fiberoptic angioscopy: role in the diagnosis of chronic pulmonary arterial obstruction.

We evaluated the role of fiberoptic angioscopy in eight patients with suspected chronic pulmonary embolic obstruction of the pulmonary arteries. Angioscopy, preceded by ventilation-perfusion lung scans, right-heart catheterization, and pulmonary angiography, resulted in diagnostic changes in four patients: from pulmonary artery agenesis to chronic emboli; from chronic emboli to normal pulmonary arterial intima (primary pulmonary hypertension); from chronic pulmonary emboli to extrinsic compression of a major pulmonary artery (fibrosing mediastinitis); and from suspected agenesis or chronic emboli to a tumor (fibrosarcoma) of the pulmonary artery. Angioscopy also more accurately determined the extent and surgical accessibility of chronic embolic obstruction in the five patients with that disorder; as a result, we decided that the obstruction in one patient was inoperable. No significant complications occurred with angioscopy and we conclude that its direct visualization capability can contribute significantly to the diagnostic evaluation of suspected chronic pulmonary arterial obstruction.

Adult↗
PubMed1976

Fluorescein angioscopy: techniques of partial fluorescence, permanent drawing record and photocoagulation.

Fluorescein angioscopy with the indirect ophthalmoscope might be the preferred technique for evaluating and treating certain lesions, particularly those in the retinal periphery. Three techniques which are helpful in extending the advantages of angioscopy are described. (1) Partial fluorescence is achieved with careful adjustment of the cobalt blue filter which relates the fluorescence to retinal landmarks, ie, color angioscopy. (2) A permanent record of angioscopy in different phases can be made with tracing paper over the retinal drawing. (3) Correct localization of lesions to be coagulated is achieved with blue filters over the coagulator beam following fluorescein injection. The filter is removed during coagulation.

Color↗
PubMed1991

Vascular endoscopy-angioscopy: current indications. A review of the literature.

Over the past 25 years angioscopy has been successfully applied in three areas of Vascular Surgery: The in situ vein femoro-popliteal bypass, thromboembolectomy procedures and in peripheral vascular reconstructions, in order to evaluate the quality of distal anastomoses. During the first one, angioscopy may be used to facilitate the cutting of the valve cusps, to locate the exact position of tributaries to be ligated and to evaluate the distal anastomosis. Benefits derived from its use, in this operation, include: small incisions instead of the thigh-long performed in order to find and ligate the tributaries, no retained valve cusps and shorter operative times since it is no longer necessary to perform completion angiogram or Doppler studies. During thromboembolectomy procedures angioscopy may be used to assess the arterial tree for remaining thrombi/emboli and to guide thrombectomy catheters into vessels that remain occluded despite repeated attempts to unblock them. Checking the distal anastomosis in peripheral reconstructions may be of benefit, as it may depict intimal flaps or misplaced sutures that may produce early graft failure. Angioscopy has also been experimentally used to assist percutaneous interventional procedures, or as a diagnostic modality in the place of angiography. The benefits derived from its use have to be weighed against the cost of the equipment and the time it takes the would-be angioscopist to become familiar with its use and the interpretation of the obtained images.

Endoscopes↗
PubMed1990

[Angioscopy of the coronary vessels].

Direct visual examination of the interior surfaces of intact human coronary arteries is now a reality, both from intraoperative and transluminal approaches. As an additional investigation to angiography it improves the knowledge about the corresponding morphology of angiographically visible changes. Since the first report about percutaneous and intraoperative coronary angioscopy by Spears et al. in 1982 important indications concerning the intraoperative approach were defined such as the control of coronary atherectomy, intraoperative balloon dilatation and laser angioplasty, the inspection of the grafts prior to implantation and the assessment of the quality of the distal anastomosis after graft insertion. The most important clinical result angioscopy has brought about is the postulation of a concept of the different clinical forms of coronary artery disease based on the morphological stages of atherosclerosis, which were defined by angioscopy and could be related to clinical symptoms. Scientific studies today are concerned with determinants for the patency rate of bypasses, the restenosis rate of PTCA, the acute and chronic effects of drugs, and the mechanism of all kinds of catheter-supported angioplasties. The next important application of coronary angioscopy will undoubtedly be the simultaneous visual control of coronary angioplasty procedures such as laser angioplasty and other new methods.

Coronary Artery Disease↗
PubMed1990

[Percutaneous angioscopy in the diagnosis of arteriopathies of the lower limbs].

Because of the poor specificity of the arteriography, the authors have performed a percutaneous angioscopy before every angioplasty of the arteries of lower limbs for nearly 3 years. They define the angioscopy and describe materials and technique. The percutaneous route without surgery and without anesthesia underlines the originality of the technique. The great difficulty is to counter-pulse the arterial inflow. The rate of saline irrigation and all the means of arterial blockade are described. In the second part, the "elementary images" are classified. The authors insist on the specificity of the angioscopy in the interpretation of arterial obstructions. Because of this specificity, the right treatment can be applied to any type of lesion. Angioscopy permits to foresee endoluminal surgery technique.

Angiography↗
PubMed1989

The use of carbon dioxide gas to displace flowing blood during angioscopy.

Carbon dioxide (CO2) gas is a safe and effective arterial contrast agent that images arteries by displacing blood. The use of CO2 gas to displace blood during angioscopy may improve intraoperative angioscopy and allow percutaneous angioscopy. To study this, 46 angioscopic evaluations in the femoral arteries of four dogs were done without inflow occlusion. The ability of CO2 gas to clear the flowing blood was compared to a high-pressure infusion of saline solution. Carbon dioxide gas successfully displaced flowing blood in 20 of 25 evaluations (80%) as compared to three of 21 evaluations (14%) with infusion of saline solution (p less than 0.0001). After the CO2 gas infusion was stopped, the image remained clear for 9 +/- 1 seconds. When saline was used, the image was clear only as long as the infusion was continued. The quality of clear images for the two media were similar through the eyepiece of the angioscope, but images observed through the motion picture camera had better contrast and depth of field in CO2 gas. The use of a CO2 gas infusion can clear the field of flowing blood without the risk of volume overloading and potentially allow performance of a successful percutaneous angioscopy.

Animals↗
PubMedDate not supplied

Intraoperative fiberoptic angioscopy to evaluate the completeness of pulmonary embolectomy.

Intraoperative angioscopy was performed in three patients who underwent pulmonary embolectomy for massive pulmonary embolism. Angioscopy followed conventional techniques such as extracting the clot by a gallstone forceps, using a Fogarty catheter in the pulmonary tree or squeezing of the lungs. The rationale for angioscopy was to assess the result of these usual "blind" techniques. In two patients residual thrombus was detected and removed under direct visual control. Our initial experience suggests that intraoperative angioscopy appears to be useful in the detection of residual thrombus material, especially in the asanguinous, arrested heart. The small size of the angioscope allows easily access to the secondary, and up to the tertiary pulmonary branches. Clots can be visualized and extracted under direct visual control.

Adolescent↗
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↗
PubMed1986

Intraoperative coronary angioscopy. Technique and results in the initial 58 patients.

Coronary angioscopy provides images of intravascular detail with greater than 0.2 mm spatial resolution and excellent contrast resolution. Using endoscopes of 1.25 to 1.8 mm outer diameter, we performed intraoperative angioscopy of the coronary arteries or saphenous vein grafts, or both, in 58 patients. Eighty-one native coronary arteries and 43 vein grafts were examined. A clear viewing field was created by infusion of crystalloid cardioplegic solution through the aortic root during cardiopulmonary bypass. Technical details crucial for obtaining high-quality images were as follows: sufficient coronary perfusion by cardioplegic solution to displace all blood; adequate intraluminal illumination; and high-quality fiberoptic and lens systems. Incomplete studies in approximately 14% of patients were related to failure to achieve these technical details and lack of scope steerability. In 30% of patients, previously unrecognized anatomic details were revealed by angioscopy. These included intimal flaps at the site of vein-to-artery anastomoses, atheromatous plaques with adherent thrombi, and hemorrhagic ulcerated plaques, not recognized on angiography. Although a coronary intimal flap developed proximal to the anastomosis during retrograde examination in two patients, no serious complications occurred as a result of the procedure. We conclude that intraoperative angioscopy is safe, provides novel information that may be clinically relevant, and has future potential for development of the techniques for coronary endarterectomy and intraoperative balloon and laser angioplasty.

Angina, Unstable↗