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.

Pseudocoarctation of the abdominal aorta.

The case of an asymptomatic pseudocoarctation of the abdominal aorta is reported. Pronounced kinking of the abdominal aorta was seen on angiograms, without stenosis or collateral circulation. Angiography revealed normal renal arteries originating from the malformated aortal segment. The possible etiology and the need for the therapeutical intervention are discussed.

[Effect of endoscopy on surgery of veins]. / Der Einfluss der Endoskopie auf die Chirurgie der Venen.

Endoscopic techniques influence the diagnosis and management of surgical problems more and more. The endoscopic subfascial dissection (ESDP) of incompetent venous perforators, which are often found in conjunction with a venous stasis ulcer, is a prime example. The two principles of surgical management, the interruption of blood flow through the perforators and the performance of a medial paratibial fasciotomy, are fulfilled with this technique. The evaluation of this new operative extraluminal endoscopic procedure using specific criteria suggests that it will become increasingly wide-spread.

[Endoscopic dissection of perforating veins]. / Endoskopische Perforansdissektion.

The eradication of incompetent perforating veins in combination with fasciotomy is an effective way of treating advanced postphlebitic leg ulcers. Our newly developed endoscopic instrument can be used with both techniques. First the superficial fasciae of the leg are split, and then the perforating veins at different levels are located, injected with anticoagulant and severed. Preliminary clinical studies have reported very encouraging results: leg ulcers healed in all cases and the venous function was improved.