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At least 109 records · Page 6Linked to original sources
PubMed1996

Angioscopy in the operating room.

Angioscopy has been used in the superficial femoral artery for many years, as well as in the control of vascular surgery procedures. It is more reliable than angiography, which often misses such features as intimal flaps, residual valves in "in situ" vein bypasses or persisting thrombus after embolectomy. As fluid irrigation allows visualization of the iliac arteries, and as smaller atraumatic fibres allow safe visualization of the tibial arteries, new fields are opened for the use of angioscopy in peripheral vascular disease. This technique has been proved to be useful: (1) as a diagnostic tool, (2) as a control device in new endovascular procedures (percutaneous angioplasty, atherectomy and stents), and (3) as a therapeutic tool (thromboembolectomy, simplification of bypass procedures). In a modern operating room, angioscopy does not replace angiography, but these two imaging techniques are complementary, as they help the surgeon to provide the patients with a less invasive vascular surgery.

Angiography↗
PubMed1996

[Intraoperative quality control after vascular surgery reconstruction of kidney and visceral arteries: personal experiences with intraoperative angioscopy].

Angioscopy was applied as a way of intra-operative assessment after surgical reconstruction of renal and visceral arteries in 15 patients. Angioscopy resulted in relevant findings, which in part, demanded immediate intra-operative consequences. Angioscopy turned out to be a sensitive way of surveillance, the findings were easy to interpret.

Angioscopy↗
PubMed1997

[Coronary angioscopy].

Coronary angioscopy evaluates the composition of the atherosclerotic plaque by direct examination of the arterial wall. The angioscope is fitted with a balloon which prevents assessment of the proximal segment of the vessels. The fibre optic system provides and excellent view of the mid and distal segments of the coronary arteries. The coronary arteries appear smooth and white on angioscopy. The atherosclerotic plaque is a white or yellowish incursion. Unstable plaques are characterised by the presence of thrombus. In unstable angina, thrombus is observed in 64% of cases and in 75% of cases during the first month after myocardial infarction. The colour of the plaque seems to be related to its fragility: the yellow plaque is much more common during myocardial infarction than in unstable angina (75% versus 47% of cases). Finally, after coronary angioplasty restenosis is more commonly white, covered by neo-intimal proliferation. Angioscopy has been shown to be feasible and safe and it is a better method of identifying thrombus. At present, it is a tool for clinical research in coronary thrombosis and interventional cardiology.

Angioplasty, Balloon, Coronary↗
PubMed1998

[The use of angioscopy in the reconstructive surgery of vascular diseases of the lower extremities].

On the basis of the literature data and original research, the value of angioscopy in reconstructive surgery of vascular diseases of lower extremities is analyzed with a report of clinical application of intraoperative angioscopy. Practical recommendations for the use of angioscopy as a method of intraoperative control of quality of reconstructive operations on lower limbs vessels are provided.

Adult↗
PubMed1998

[Intraoperative angioscopy in vascular reconstructive surgery].

Based on the data available in the literature and their own findings, the authors analyzed the value of angioscopy in the reparative surgery of low limb vessels. Some cases of clinical application of intraoperative angioscopy are described and guidelines for the use of angioscopy as an intraoperative control of the quality of reparative surgery on low limb vessels.

Adult↗
PubMed1998

[Angioscopy associated with renal transplantation].

OBJECTIVES: To evaluate the usefulness of backtable angioscopy of renal allograft previously to kidney transplantation (KT). METHODS: Twenty five allografts from high risk vascular donors have been angioscopically evaluated. Donors were older than 50 years, with severe aortic atheromatosis, polytraumatized, with cardiac arrest or with vascular lesions or anatomic anomalies of the renal vessels. RESULTS: Forty four per cent (11/25) of the grafts showed vascular pathology on angioscopy: subintimal hematoma (2), intimal tear (2), atheroma plaques (2), venous thrombosis (1) and bench microsurgical vascular reconstruction (4). CONCLUSION: Renal allograft angioscopy is useful in selected cases. It allows to evaluate vascular state of the graft and the quality of microsurgical vascular reconstructions.

Angioscopy↗
PubMed1990

A comparative study of intraoperative angioscopy and completion arteriography following femorodistal bypass.

A prospective comparison of the findings on standard completion arteriography with those seen using videoangioscopy was done following 49 cases of "femorodistal" bypass grafting in 47 patients. The two techniques were compared with respect to the detection of technical defects, modification of the surgical procedures, early graft patency (72 hours), and complications. Completion arteriography was specific (95%) but only moderately sensitive (67%) compared with angioscopy for detection of technical problems. Following angioscopy, significant alterations in the surgical procedure were noted in 5 (10%) of the 49 cases. Early graft failure occurred in 3 (6.1%) cases but none were identifiably due to technical problems. Four patients suffered postoperative myocardial infarctions, 2 (4.2%) of which were fatal; no patients had contrast-induced allergies or renal failure. Angioscopy was measurably more accurate for the detection of technical problems than completion arteriography, but offered little information about distal arterial anatomy that may have an impact on graft patency or the use of antithrombotic therapy.

Aged↗
PubMed1991

Angioscopy of arm vein infrainguinal bypass grafts.

Between January 1988 and December 1990, 56 patients underwent 66 arm vein infrainguinal bypass grafts for limb salvage. Thirty-nine grafts were intraoperatively monitored by the standard methods of continuous wave Doppler alone (30) and arteriography (9). Twenty-seven grafts were prepared and monitored by intraoperative angioscopy. No significant findings requiring intraoperative revision or correction were noted in the grafts monitored by the standard methods. However, in those grafts prepared and monitored by angioscopy, intraluminal abnormalities of the arm veins were detected and corrected in 20/27 (74%). None of the grafts prepared or monitored by angioscopy occluded within 30 days, whereas, in those grafts monitored by continuous wave Doppler and arteriography, 7/39 failed within 30 days, a primary patency rate of 32/39 (82%) (x2 with yates correction, p = 0.055). This study shows that angioscopic preparation and monitoring of arm vein bypass grafts allows the detection and correction of unsuspected intraluminal abnormalities, which appears to improve the early primary patency of arm vein infrainguinal bypass grafts.

Aged↗
PubMed1988

Fiberoptic angioscopy of cardiac chambers, valves, and great vessels using a guiding balloon catheter in dogs.

The applicability of fiberoptic angioscopy with a guiding balloon catheter to observe the cardiac chambers, valves and the great vessels was examined in anesthetized dogs. A No. 11 French guiding balloon catheter (balloon diameter 50 French) was introduced through either the right jugular vein or the right femoral vein into the right heart, and then a fiberscope (4.3 French in diameter) was introduced through the catheter into the right heart in 10 dogs. The balloon was inflated with air and gently pushed against the luminal surface, warm saline was infused through the catheter to displace the blood, and the luminal surfaces were photographed on 16 mm color cinefilms. Pulmonary angioscopy was also performed in these dogs. Similarly, the guiding catheter and fiberscope were introduced through the right common carotid artery into the left ventricle for observation of the luminal changes in the other 10 dogs. The luminal surfaces of the superior vena cava, right atrium, right ventricle, and pulmonary artery could be observed in all dogs. The trabeculae of the left ventricle, contracting and relaxing synchronously with the cardiac beat, could also be observed in all dogs. However, observations of the tricuspid valve, aortic valve, papillary muscle, and chordae were successful in only some dogs. Postmortem examinations revealed no obvious endocardial or intimal damage. The results indicate the applicability and safety of angioscopy guided by a balloon catheter for observations of the luminal changes in the cardiac chambers and great vessels.

Animals↗
PubMed1991

Role of angioscopy in the treatment of peripheral vascular disease with percutaneous atherectomy.

The role of adjunctive video angioscopy was evaluated in 43 patients with symptomatic peripheral vascular disease undergoing percutaneous atherectomy with the Simpson atherocath. There were 57 target lesions (superficial femoral, n = 46; popliteal, n = 11) of which 33 were stenotic (86 +/- 11%) and 24 were total occlusions of 0.5 to 10.6 cm in length, determined by angiography. Intraluminal inspection, with angioscopes of 0.85 to 1.5 mm in outer diameter housed within a guide catheter, could be performed in 55 of 57 lesions (96%) before atherectomy and in 39 of these 55 (71%) after atherectomy. Failure to obtain an adequate image was usually due to insufficient irrigation, especially in recanalized vessels. In 13 of 23 successfully recanalized arteries (54%) the occlusion could be crossed by the angioscope itself, whereas in 10 cases (42%) a guidewire or a sheath introducer was necessary. Angioscopic passage revealed that often long total occlusions, determined by angiography, consisted of greater than or equal to 1 discrete occlusion with interposed patent thrombus-free vascular segments. After atherectomy, in 15 instances with an acceptable angiographic result, angioscopy was helpful in identifying residual plaques and flaps which then selectively underwent atherectomy. In conclusion, angioscopy proved to be a useful adjunct to angiography in optimizing vascular recanalization with percutaneous atherectomy.

Adult↗
PubMed1989

Percutaneous video angioscopy in peripheral vascular disease.

Percutaneous video angioscopy was performed using high resolution thin angioscopes in 12 peripheral arteries in 10 patients with peripheral vascular disease, to study the intraluminal appearance before and after dynamic, laser and conventional balloon angioplasty. Clear blood free views of the whole length of artery instrumented were obtained in 10 arteries with the remaining two arteries being partially visualised. The angioscopic appearances were compared to angiography. Clinically significant findings were detected in all the arteries by angioscopy that were not found by angiography. These included thrombus in the artery and vascular sheath, intimal flaps and fractured atheroma. The angioscopic findings helped to assess the effects of angioplasty in different types of occlusion. The findings demonstrate the potential of percutaneous angioscopy as an aid to percutaneous angioplasty as well as being a powerful diagnostic procedure.

Aged↗
PubMed1985

Coronary angioscopy during cardiac catheterization.

Coronary angioscopy should permit direct inspection of the luminal cross section and identification of disease. The feasibility of introducing a 5F Olympus Ultrathin fiberscope into the obstructed right coronary artery in five patients after routine cardiac catheterization by the brachial approach was therefore tested. An 8.3F USCI woven Dacron angioplasty guiding catheter was modified to enlarge its lumen. After engaging the right coronary ostium with the catheter, an attempt was made to pass the angioscope coaxially to the tip of the catheter. Visualization of the coronary lumen was then achieved in three patients by manually injecting 5 to 10 cc of normal saline solution through the guiding catheter at 2 to 3 cc/s. White atheromatous plaque could be seen near the site of obstruction in each case. In two patients, a lack of sufficient flexibility in the distal 2 cm of the angioscope prevented passage to the catheter tip. Preliminary experience with a videoendoscopic system suggests that this monitoring technique is essential for the adequate performance of angioscopy and for recording dynamic changes during blood displacement. Geometric distortion of the image and nonlinearities in magnification and light reflex with a decreasing lens to object distance make quantitative evaluation of the lumen difficult. Lack of an angulation system further contributes to this problem and, more importantly, restricts passage of the angioscope to the proximal 1 to 2 cm segments of coronary arteries. Although coronary angioscopy may have research and clinical applications in the future, these technical problems should first be addressed.

Angiography↗
PubMed1986

Coronary angioscopy in patients with unstable angina pectoris.

To visualize intracoronary lesions in patients with different clinical expressions of coronary disease, we performed coronary angioscopy during coronary-artery bypass surgery in 10 patients with unstable angina and 10 patients with stable coronary disease. We examined a total of 32 vessels, using flexible fiberoptic angioscopes. Twenty-two vessels had no acute intimal lesion; three had complex plaques, six had thrombi, and one had both. Coronary angiography correctly identified the absence of complex plaque and thrombus in 22 vessels, but it detected only one of four complex plaques and one of seven thrombi. On angioscopy, none of the 17 arteries in the patients with stable coronary disease had either a complex plaque or thrombus. In the "offending" arteries of the patients with unstable angina, all three patients with accelerated angina had complex plaques and all seven with angina at rest had thrombi. We conclude that angioscopy frequently reveals complex plaques or thrombi not detected by coronary angiography. Our observations suggest that anginal syndromes that are refractory to medical treatment can be caused by unstable pathologic processes in the intima. Ulceration of plaques may increase the frequency and severity of effort angina, and the subsequent development of partially occlusive thrombi may cause unstable rest angina.

Adult↗
PubMed1985

Delineation of peripheral and coronary detail by intraoperative angioscopy.

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

Angioplasty, Balloon↗
PubMedDate not supplied

MR virtual angioscopy of thoracic aortic atherosclerosis in homozygous familial hypercholesterolemia.

PURPOSE: The thoracic aorta is an important site of atherosclerotic disease in patients with homozygous familial hypercholesterolemia (HFH). Thoracic aortic atherosclerosis in patients with HFH was assessed with contrast-enhanced MR angiograms using exoscopic and endoscopic virtual angioscopy reconstructions and maximum intensity projections (MIPs). METHOD: Contrast-enhanced MR angiograms of the thoracic aorta of 15 patients with HFH and 8 normal volunteers were obtained. Perspective surface reconstructions of the MR angiograms including virtual angioscopy views were evaluated by three radiologists blinded to the diagnosis. RESULTS: Thoracic wall irregularity was depicted on 8 of 15 (53%) patient scans and only 1 of 8 (13%) normal subject scans using surface reconstructions. Wall irregularity scores of patients with HFH were significantly increased compared with controls (2.0 +/- 0.9 vs. 1.0 +/- 0.6; p = 0.008). There was excellent interobserver agreement (weighted kappa = 0.82 +/- 0.12). Virtual endoscopy views added diagnostic confidence compared with exoscopic surface renderings alone. MIP reconstructions were unable to depict wall irregularity. CONCLUSION: MR angiography with virtual angioscopy of the thoracic aorta depicts nonstenotic wall irregularity of thoracic aortic atherosclerosis in patients with HFH. This may be important for assessing disease progression and response to treatment and may be generalizable to routine (non-HFH) atherosclerosis.

Adult↗
PubMed1985

Percutaneous angioscopy. Work in progress.

The cardiovascular applications of flexible fiber-optic technology are imminent because of recent advances in miniaturization. In the work described here, angioscopy, or vascular endoscopy, was performed in the cadaveric aorta and in the systemic and pulmonary circulations of the canine model and selected human patients. Subsequent to our development of percutaneous techniques, clinical trials have ranged from lower-extremity venoscopy to aortic-root arterioscopy. Angioscopy could be clinically useful because of relative or absolute contraindications to iodinated contrast material. The ability to see in color and three dimensions may afford some other advantages to angioscopy over conventional angiography.

Animals↗
PubMed1984

Hemodynamics and gas exchange during angioscopy in the dog.

We have previously developed a technique for the in vivo visualization of the pulmonary arteries in the experimental animal with a fiberoptic instrument (angioscope). To assess the potential hemodynamic and gas exchange effects of angioscopy, we studied five dogs before and after pulmonary embolization. Sequential observations were made of arterial blood gases, mean arterial pressure, pulmonary artery pressure, heart rate, cardiac output, and the electrocardiogram. The most common arrhythmias were ventricular premature contractions which were comparable to those seen with right heart catheterization. Statistically significant, but clinically minor, effects were found on cardiac output, mean arterial pressure, and heart rate in dogs when angioscopy was performed after pulmonary embolization. We conclude that fiberoptic angioscopy does not induce deleterious effects on hemodynamics or gas exchange in the experimental animal, prior to or after embolization.

Animals↗
PubMedDate not supplied

[Angioscopy, the potentials and limits of its use in angiology and vascular surgery].

Possibilities from arterial and venous angioscopy in the diagnostic, angioplasty and surgical protocols are analyzed. Indications for angioscopy, additional informations compared to angiography and potentials for endovascular therapy guided by angioscopy will be discussed according to personal preliminary experience and review of the bibliography.

Blood Vessels↗