Intraoperative control following femorodistal revascularization: angioscopy is superior to angiography.

ABSTRACT

Intraoperative angioscopic control was performed in an early series of 27 patients undergoing peripheral vascular surgery. The majority were complex or re-do operations; reversed saphenous vein and PTFE-grafts were used as bypass material exclusively. Angioscopic findings were compared to conventional angiography with respect to the detection of technical problems leading to further surgical procedures. Angioscopy was feasable in 92.5%, it failed twice due to irrigation problems, which was before we used a dedicated angioscopy roller-pump. In 6 patients relevant findings requiring further surgical manipulations were only detected angioscopically, in 2 patients such findings were detected by angioscopy as well as by angiography. Such findings included technical problems (graft rotation [n = 1], anastomotic narrowing [n = 2]), balloon catheter injuries after thromboembolectomy (n = 2) and residual thrombi after local thrombectomy (n = 3); 5 of these patients had undergone previous vascular procedures in the same operation field. After local correction (n = 5) or placement of a new bypass (n = 3) there was no early graft failure. This early angioscopic experience confirmed previous reports that satisfactory visualization and specific recognition of angiographically unsuspected problems after peripheral reconstructions can be obtained by intraoperative angioscopic control. This was seen very distinctively in more complex and re-do operations, which we see as the cases most needing routine angioscopic control.