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.
Kwolek
C J
CJ
Harvard-Deaconess Surgical Service, Division of Vascular Surgery, New England Deaconess Hospital, Boston, Massachusetts.
Miller
A
A
Stonebridge
P A
PA
Lavin
P
P
Lewis
K P
KP
Tannenbaum
G A
GA
Gibbons
G W
GW
Pomposelli
F B
FB
Freeman
D V
DV
Campbell
D R
DR
D000792:Angiography / Q000706:statistics & numerical data; D001166:Arteriovenous Shunt, Surgical; D001808:Blood Vessels; D003287:Contrast Media; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; D004338:Drug Combinations; D004724:Endoscopy / Q000706:statistics & numerical data; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D012965:Sodium Chloride / Q000009:adverse effects*; D007507:Therapeutic Irrigation
D003287:Contrast Media; D004338:Drug Combinations; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; D012965:Sodium Chloride; C027278:urovision