The role of routine angioscopy in vascular access surgery.
OBJECTIVE
The purpose of this retrospective study is to describe our techniques, review our experience, and determine the feasibility, safety, and role of the routine use of angioscopy during primary and revision vascular access surgery.


METHODS
Between February 1991 and October 1993, intraoperative angioscopy was routinely performed in 84 consecutive operations (51 patients) for vascular access surgery. We reviewed the videotaped recordings of the angioscopic studies together with the clinical data according to a predetermined protocol.


RESULTS
There were 43 primary procedures (36 autogenous arteriovenous fistulas and 7 bridge graft fistulas) and 41 revision procedures for failed vascular access (7 autogenous arteriovenous fistulas and 34 graft bridge fistulas). In 20.9% of the primary vascular access procedures, abnormal endoluminal findings were noted. Based on these findings, only one additional intervention was performed. In revision vascular access surgery, abnormal endoluminal findings were noted in 92.7%, resulting in additional surgical interventions in 65.9% of the procedures. In the revised synthetic bridge graft fistulas, stenosis of the midgraft (n = 9) as a result of needle insertion for dialysis was more common than at venous anastomosis (n = 4). Detection and correction of endoluminal abnormalities resulted in a 30-day patency of 66.6% as opposed to 33.3% when none was detected (p < or = 0.012, Fisher's exact test).


CONCLUSIONS
Routine angioscopy is technically feasible and can be performed safely in anuric patients during vascular access surgery. It provides additional and useful intraoperative information that may significantly alter the surgical procedure. Routine angioscopy may also provide new insights into the pathophysiology of vascular access failure.
Hölzenbein
T J
TJ
Department of Surgery, MetroWest Medical Center, Framingham, MA 01701, USA.
Miller
A
A
Gottlieb
M N
MN
Gupta
S K
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy; D002408:Catheters, Indwelling; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D014656:Vascular Surgical Procedures / Q000379:methods*
D011138:Polytetrafluoroethylene