A blinded comparison of angiography, angioscopy, and duplex scanning in the intraoperative evaluation of in situ saphenous vein bypass grafts.
Angiography, angioscopy, and duplex scanning have each been advocated for intraoperative assessment of in situ saphenous vein grafts. We compared these three modalities during operation in a prospective, blinded study during the construction of 20 femoral-infragenicular in situ saphenous vein grafts. Each modality was used and interpreted by a surgeon blinded to the results of the other studies. Abnormalities requiring intervention were defined as (1) patent vein side branches, (2) residual valve cusps, and (3) anastomotic stenoses greater than 30%. Criteria, specific to the modality, corresponding to each category were prospectively defined. Fourteen residual valve cusps, 49 patent vein branches, and 6 anastomotic stenoses were suggested by at least one modality. Nine residual valve cusps, 32 patent vein branches, and no anastomotic stenoses were actually found (and corrected) by direct inspection. Sensitivity of detecting patent side branches for angiography, duplex scanning, and angioscopy was 44%, 12%, and 66%, respectively. Both angiography and angioscopy were significantly more sensitive than duplex scanning for detection of unligated side branches (p less than 0.01). Sensitivity of detecting residual valve cusps was 22% (angiography), 11% (duplex scanning), and 100% (angioscopy). Angioscopy was significantly more sensitive than either duplex scanning or angiography in detection of residual valve cusps (p less than 0.01). Since no anastomotic stenoses were confirmed, the false-positive rates for stenosis detection were 20% for angiography, 10% for duplex scanning, and 0% for angioscopy. Time requirement was 17 to 20 minutes and did not differ among the three modalities. No stenosis or arteriovenous fistula has been detected in any graft by postoperative duplex surveillance (mean, 10-month follow-up).(ABSTRACT TRUNCATED AT 250 WORDS)
Gilbertson
J J
JJ
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756.
Walsh
D B
DB
Zwolak
R M
RM
Waters
M A
MA
Musson
A
A
Magnant
J G
JG
Schneider
J R
JR
Cronenwett
J L
JL
D000714:Anastomosis, Surgical; D004724:Endoscopy; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D016343:Monitoring, Intraoperative; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014463:Ultrasonography